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AN-SNAP V4 User Manual - Australian Health Services Research

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1. 9 METeOR website can be found at http meteor aihw gov au content index phtml itemld 181414 AN SNAP V4 User Manual 43 CHSD centre for health service development Episode of subacute or non acute care An episode of subacute or non acute care is a period of contact between a subacute or non acute patient and a health service that is of the same care type that occurs in either a hospital or in the community An episode of subacute care may be on an admitted or non admitted basis An episode of admitted subacute care may be provided on a same day or overnight basis Multidisciplinary For the purpose of assignment to an AN SNAP class multidisciplinary care is defined as services provided jointly by a team that consists of more than one professional discipline This team generally includes allied health nursing and medical practitioners In the non admitted subacute setting multidisciplinary may not be limited solely to health care delivered by different professional disciplines It can include health care provided by one professional who is backed up and supported by other disciplines In this context multidisciplinary management would include participation in a multidisciplinary case conference convened in order to review the findings of the assessment and to develop a case management plan It also includes access to other disciplines for consultation and referral as required and the mechanism for ongoing multidisciplinary revi
2. toxic traumatic or other Brachial plexus or lumbosacral plexus injury 3 4 Neurologic Conditions Acute inflammatory Brain Guillain Barr Syndrome polyneuritis Do NOT use this code for cases with Cerebral Palsy with Selective Dorsal Rhizotomy if deficits include new weakness These should be classified to Non Traumatic Spinal Cord Dysfunction 4 111 4 13 3 5 Neurologic Conditions Cerebral Palsy 3 8 Neurologic Conditions Neuromuscular Disorders AN SNAP V4 User Manual Cerebral Palsy Neuro Cerebral palsy with orthopaedic surgical intervention or fracture Cerebral palsy with neurosurgical intervention excludes SDR Cerebral palsy with Intrathecal Baclofen pump Rehabilitation following other procedure in person with Cerebral palsy Post poliomyelitis post polio syndrome Motor neurone disease Neuro Myasthenia gravis Muscular dystrophies and other myopathies 54 CHSD centre for health service development AROC Impairment Code 3 9 Neurologic Conditions Other Neurologic disorders 4 111 Non Traumatic Spinal Cord Dysfunction Paraplegia Incomplete 4 112 Non Traumatic Spinal Cord Dysfunction Paraplegia Complete 4 1211 Non Traumatic Spinal Cord Dysfunction Quadriplegia Incomplete C1 4 4 1212 Non Traumatic Spinal Cord Dysfunction Quadriplegia Incomplete C5 8 4 1221 Non Traumatic Spinal Cord Dysfunction Quadriplegia Complete C1 4 4 1222 Non Traumatic Spinal Co
3. A AN SNAP Error Classes Adult Error Classes Admitted adult rehabilitation ungroupable Admitted adult palliative care ungroupable Admitted geriatric evaluation and management ungroupable Admitted psychogeriatric care ungroupable Admitted non acute care ungroupable Admitted paediatric rehabilitation ungroupable Admitted paediatric palliative care ungroupable Non admitted adult rehabilitation ungroupable Non admitted adult palliative care ungroupable Non admitted geriatric evaluation and management ungroupable Non admitted psychogeriatric care ungroupable Non admitted paediatric rehabilitation ungroupable Non admitted paediatric palliative care ungroupable All other ungroupable occurs when there is an error with Episode Type Care Type or Age Admitted Non Admitted 4998 4997 GEM 499C 499U Rehabilitation 499A 499S Psychogeriatric 499D 499V Non Acute 499E A a Paediatric Error Classes Non Admitted Rehabilitation 499F 499X 499G 4997 All other ungroupable 4999 Occurs when there is an error with Age Care Type or Episode Type AN SNAP V4 User Manual 74 CHSD centre for health service development APPENDIX 4 4AZ3 4AA7 4AH2 4AH3 4AH4 N BIPI IPI B N N N N RRL RIL RTA N N N N N BIPIPIPISI B N N N gt P bP DP P gt gt gt gt P bP bP DP D gt gt gt gt gt P P P IP P P gt gt gt I m m mil m w U U J OLlN
4. Also PCPSS item scores are added to create a PCPSS total score that is used for grouping The non admitted episodes are split into four groups based on palliative care phase Two of the phase groups unstable and deteriorating are then split using the variables RUG ADL total score and PCPSS total score Admitted and non admitted paediatric palliative care Inthe admitted branch same day records are split from the overnight records into a single class The overnight episodes with a phase type of terminal are split into a single class For those episodes where the patient is not in a terminal phase episodes for children who are less than one year old are split into a single class Episodes where the patient s age is one year or more are then split by palliative care phase into stable or complex unstable or deteriorating as shown in Appendix 2 AN SNAP V4 User Manual 21 CHSD centre for health service development Admitted GEM Same day records are split from the overnight records into a single class All FIM motor item scores collected on admission must be available and valid For the overnight admitted episodes the 13 FIM motor item scores are added to create a FIM motor score for each episode The overnight episodes are split into three groups using the FIM motor score Each of these groups based on motor function is then split into two depending on whether or not any of the diagnoses recorded
5. Manual 11 CHSD centre for health service development For example a rehabilitation patient who is 16 or 17 may be treated in an adult unit Practically it may be more sensible to group all patients in the unit to the adult classes Alternatively a paediatric unit may want to classify any 18 or 19 year old patients treated into the paediatric classes To accommodate such circumstances only for patients between the ages of 16 and 19 inclusive the AN SNAP grouper will accept the use of an indicator variable Age Type that can be used to specify whether a rehabilitation or palliative care episode should group to a paediatric or an adult class This variable would be used instead of the patient s age to decide between the paediatric or adult branches during the grouping process Use of this variable would require the service provider to ensure that the relevant range of clinical tools and data items are available for assessing the patient 2 2 3 Error classes Several error classes have been included in AN SNAP V4 One is an overarching error class for episodes phases where missing data on care type age or episode type which specifies treatment setting preclude grouping to a care type branch The additional error classes are used for episodes phases where other variables required for grouping are missing Within the admitted branch of the classification there are seven error classes one for each of the care type age combi
6. Paediatric vs adult rehabilitation or palliative care rrrrannrrrnnnnrrnnnnnnrrnnnnnnrrnnnnneree 20 3 3 3 Splits within care TYPE cece cceseeccceesscecceeeeeeceesecceeeeaececseasecesseaeceeeauaseesssaeeeesageess 20 3 4 Other factors that may affect grouping cccccccsssecccccessceceeseececeeneeeeeeuasceeseeneceesegeses 23 4 The AN SNAP V4 admitted cClasSes rrrrnnrnrrnnannrrnnnnnnernnnnnnrrnnnnnnrnnnnnnsrnnnnnnvrnnnnesennnnnnsvnnnneneennnn 25 5 The AN SNAP V4 non admitted classes rrrrrnrnnnrrnnnnnnrrnnnnnnrrnnnnnernnnnnnernnnnnnrnnnnnnsvnnnnnnssnnnnneeee 36 APPENDIX 1 BL ol EEE NE 43 Her 80140 1 1 9 EE EE EE ENE 43 Australian National Subacute and Non acute Patient Classification AN SNAP sesse 43 VITEN 43 Episode of subacute or non acute Care rrrrrrrrrrannrrrrnnnnrrnnnnnerrnrnnerrrnnnnnennnnnnerrnnnnseernnnnnssennunsseee 44 MN 44 AN SNAP Care type definitions rrarrrrnnnnnrrnnnnnnrrnnnnnerrnrnnnnrrnnnnnnrnnnnnennnnnnsnvennnnssennnunesennnnsesennnnsssennn 44 ee Eee ON C IT JE EEE 44 PINE AN O aad oets cviacameastneihestonrucetesons c1esuere E 45 Geriatric evaluation ANd management ccccccssscccccssscecceeeeececeeseecseaeeeceesuseccessunecessageeeessgeeees 45 Pre 45 NENNE 46 AN SNAP V4 User Manual 2 CHSD centre for health service development Patient Episode Phase definitions cccccccccccccccccececcceeeeeeeuceeesescseeceeeececessseueeeseeueueueeseneeeeess 46 FL 46 Episode
7. SNAP V4 User Manual 12 CHSD centre for health service development Age palliative care rehabilitation non acute and to identify paediatric episode phases Age Type optional an indicator variable that overrides age to decide between the paediatric and the adult classes for rehabilitation and palliative care see Appendix 2 Length of stay LOS psychogeriatric and non acute Same day flag to distinguish between same day and overnight episodes phases The following additional variables are included in the non admitted classes of AN SNAP V4 Problem severity palliative care Focus of Care psychogeriatric care Assessment only rehabilitation and psychogeriatric Clinic type GEM Single day of care without ongoing care plan GEM Multidisciplinary all care types The specific variables required for grouping within each care type are provided below Many of the variables used to group to AN SNAP V4 are scores on recognised clinical assessment tools The items and corresponding scores of these clinical tools are provided in Appendix 2 References to websites with further details of these tools are provided below In addition IHPA maintains an Admitted Subacute and Non Acute Hospital Care Data Set Specification DSS which includes the data elements required to group admitted subacute and non acute patient episodes phases of care to an AN SNAP class 2 3 1 Rehabilitation In AN SN
8. TY EE 46 MENN 47 Episode of admitted patient Care rrrrrnrrrrrrannrrrnnnnnrrnnnnnnrrnrnnerrnnnnnnernnnneeernnnnesennnnnsernnnnsssennn 47 Episode start admitted subacute Care rrrnnnnrrnnnnnrrnnnnnernnnnnnnrrnnnnnnrrnnnnesennnnnssrnnnnsssennnnesennnn 47 Episode end admitted subacute Care rrrnnrnrrnnannnrnrnanernnnnnnnrrnnnnsnernnnnernnnnnnssvnnnnsssennnnssennnn 47 Nomadmited patici ccncsciscnvsucnesconaiacdunsiedsaneansensnbaleenconeereeeuesiandaieatencthdueacthdnedasesoudaiadidyiaaninndssanes 47 Episode of non admitted patient Care rrrrnnnnnrrnnnnnnrnnnnnernnnnnnnrrnnnnenrrnnunernnnnnnesennnnssennnnsseennn 48 Episode start non admitted subacute Ccare rrrrnrnnnnnnnnnrrnnnnrrnnnrrnnnrsnnnnnnnnnssnnsnnnennssnsnnnenee 48 Episode end non admitted subacute Care rrrrrnnnnnrnnnnnnrnnnnnnernnnnnnnrrnnnnnrnnnnnnernnnnnsesennnsesennnn 48 Single day of care without ongoing care plan rrrrrrrrrnnnnrrrrnnnrrrrnnnnnrrnnnnnrrnnnnnerrnnnnneernnnnneeee 48 PENN 48 TEN 48 Phase of palliative Cafe picnics nen E N a 48 Palliative care OE SS 49 Palliative care phase ON cccccssssccccseeccceeseeceesusseceeaeeeecseneceeeaeaeeesegeeeesaneeeesauaseeeseageeessees 49 M NNN 49 Ne ORRE EEE EE 49 Pee NN 49 TN MN 49 EONA la 0 EE NE TE TEEN 50 First phase in palliative care episode rrrrrnrrrrnrannrrrrnnnnrrnnnnnnrrnrnnerrrnnnnnernnnnseernnnnseernnnnnssnnnnnnesee 50 ENN 50 APPENDIX 2 Clinical tools used to def
9. aiaiai 67 Table 21 HoNOS 65 Item 8A additional information ccccccesecccesecccseecceeneceeeneceseneceneeeees 68 TE PSN 70 Table 23 RUG ADL items and SCOPES ccccsesesesccssccccssenccesccccescencussencusceneusuencusueneusrencusrencuens 71 List of Figures Figure 1 AN SNAP Version 4 Structure rrrnnrrnnnrnnnrnnnrnnnennnsnnnnrnnnennnvnnnnnnnennnsnnnnvnnnvnnesennnnnnsnnnnee 10 Figure 2 Admitted adult rehabilitation branch rererornrnnnnnrrrrnrnnnnerrrnnrnnnnnrrnnvnnnnsnsrnnvnnnnsssnnnnne 26 Figure 3 Admitted paediatric rehabilitation branch rrrrnnrrnnnnrrnnnnernnnnrrnnnnrrnnnnnrnnnnernnnnennnnneene 30 Figure4 Admitted adult palliative care branch rerrrrrnrnnnnnrrrrnrnnnnnrvrnnrnnnnnsrnnvnnnnsrrrnnnnnnnerennnnne 31 Figure5 Admitted paediatric palliative care branch rrrnnnrrnrnnrrnnnnnrnnnnnrnnnnvrnrnnernnnnnrnnnnsnnnnneene 32 Figure 6 Admitted GEM branch rrrrnnnnrrnnnnnrrnnnnnernnnnnnrrrnnnnnrrnnnnnsrnnnnnnernnnnssennnnnnsnnnnsnsrnnnnnesennenee 33 Figure 7 Admitted psychogeriatric branch cccccccssseccccessecccceesececeeeeccesaeecessueecesseneeeesuagees 34 Figure 8 Admitted non acute branch rrarnnnannrnnnnnnnrrnnnnnrrrnnnnernnnnnnnernnnnevennnnnesnnnnnnnsrnnnnssennnnnee 35 Figure9 Non admitted adult rehabilitation branch rrrrrnnrrnrnnrrnrnnrrnnnnrrnnnnrnnnnnrrnnnnernnnnennnnneeee 37 Figure 10 Non admitted paediatric rehabilitation branch r rrrrrrnnnnrrnnnnnnrrnnnnnrrnnnnnnern
10. branch Non Admitted Non Admitted Paediatric Palliative Care Paediatric Age lt 17 Ungroupable Palliative Care 499Y Phase Type Age lt 1 Not Terminal 4Y01 Phase Type Age gt 1 Stable 4Y02 Phase Type Unstable or Deteriorating 4Y03 Phase Type Terminal 4Y04 Table 12 Non admitted paediatric palliative care classes 4Y01 Palliative Care Not Terminal phase Age lt 1 year 4Y02 Palliative Care Stable phase Age gt 1 year 4Y03 Palliative Care Unstable or Deteriorating phase Age gt 1 year 4Y04 Palliative Care Terminal phase 499Y Paediatric Non admitted Palliative Care Ungroupable AN SNAP V4 User Manual 40 CHSD centre for health service development Figure 13 Non admitted GEM branch Non Admitted GEM Ungroupable 499U Non Admitted GEM Single day of care without ongoing care plan 4UC1 Falls Clinic 4UC2 Memory Clinic 4UC3 Other Clinic 4UC4 Table 13 Non admitted GEM classes Code Description 4UC1 Single day of care without ongoing care plan 4UC2 Falls clinic 499U Non admitted GEM Ungroupable AN SNAP V4 User Manual 41 CHSD centre for health service development Figure 14 Non admitted psychogeriatric branch Nicene miited Non Admitted Psychogeriatric Psychogeriatric Ungroupable AA 499V Assessment Only 4vVY1 Focus
11. community setting is grouped in the non admitted branch AN SNAP V4 User Manual 46 CHSD centre for health service development Admitted patient An admitted patient follows the process where a hospital or health service accepts responsibility for the patient s care and or treatment Admission follows a clinical decision based upon specified criteria that a patient requires same day or overnight care or treatment An admission may be formal or statistical Formal admission The administrative process by which a hospital records the commencement of treatment and or care and or accommodation of a patient Statistical admission The administrative process by which a hospital records the commencement of a new episode of care with a new care type for a patient within one hospital stay Ref METeOR ID 445933 Episode of admitted patient care The period of admitted patient care between a formal or statistical admission and a formal or Statistical separation characterised by only one care type Ref METeOR ID 268956 Episode start admitted subacute care An episode of subacute care begins on the day that the medical record is documented with evidence that the person meets the criteria for one of the subacute care types This may be the same as the date the person was admitted to hospital or a date during the hospital stay Episode end admitted subacute care An episode of subacute care ends when either the principa
12. condition The patient will be capable of actively participating AN SNAP V4 User Manual 44 CHSD centre for health service development Rehabilitation care is always delivered under the management of or informed by a clinician with specialised expertise in rehabilitation and evidenced by an individualised multidisciplinary management plan which is documented in the patient s medical record that includes negotiated goals within specified time frames and formal assessment of functional ability Ref METeOR ID 491557 Palliative care Palliative care is care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life limiting illness The patient will have complex physical psychosocial and or spiritual needs Palliative care is always delivered under the management of or informed by a clinician with specialised expertise in palliative care and evidenced by an individualised multidisciplinary assessment and management plan which is documented in the patient s medical record that covers the physical psychological emotional social and spiritual needs of the patient and negotiated goals Ref METeOR ID 491557 Geriatric evaluation and management Geriatric evaluation and management is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with multi dimensional needs assoc
13. each record in the input data file must represent an episode or for palliative care a phase of care This is the case for overnight admitted and for non admitted activity The exception is same day activity for which the unit of counting is the day of care This is a result of the way these data are currently collected where it is not possible to group together the days of same day activity that could be grouped together to create an episode of care 3 3 The grouping process The process of grouping records to AN SNAP V4 can be summarised as follows Identify the record as admitted or non admitted Check that a non admitted record is multidisciplinary Identify the care type based on the characteristics of the patient and the primary clinical purpose or treatment goal rather than the specialisation of the treating physician or the type of facility in which the treatment is provided For rehabilitation and palliative care identify the record as adult or paediatric Identify admitted records as overnight or same day Test that required variables are available and valid Calculate total assessment scores where required including the weighted FIM motor score for adult admitted rehabilitation and Group to AN SNAP V4 class 3 3 1 Treatment setting and care type splits The first split of the classification is on admitted versus non admitted Only multidisciplinary care groups to the AN SNAP V4 non admitted classes If it i
14. episode of same day activity as in previous versions of AN SNAP In turn this means that the same day classes differ from the non admitted classes both in terms of the grouping variables used in class assignment and in the unit of counting of the class It is recognised that decisions regarding whether to treat a patient on a same day admitted or outpatient basis often reflect local admission policies rather than clinical differences between patients It would therefore be preferable for same day admitted and non admitted activity to be assigned to the same AN SNAP classes However classes for same day activity have been incorporated into the admitted branch of AN SNAP V4 to allow the assignment of an AN SNAP class within current admitted and non admitted data collections This discrepancy should be considered further in future versions of AN SNAP AN SNAP V4 User Manual 9 CHSD centre for health service development Figure 1 AN SNAP Version 4 Structure Episode Type Admitted Subacute Overnight 83 classes Same Day 6 classes Non acute 6 classes Care Type Rehabilitation Adult Age gt 18 Rehabiliation Overnight 50 classes 4A Same Day 1 class 4JO1 Paediatric Age lt 17 Rehabilitation Overnight 5 classes 4F Same Day 1 class 4001 y Palliative Care Adult Age gt 18 Palliative Care Overnight 12 classes 4B Same Day
15. for the patient is delirium or dementia to create the AN SNAP V4 classes Non admitted GEM The record to be grouped to AN SNAP V4 should represent an episode of care This may require amalgamation of a series of service event records There are four non admitted GEM classes based on whether the episode is a single day or part of a longer program If it is a longer program then there are three classes based on the clinic type Admitted psychogeriatric Same day records are split from the overnight records into a single class All HONOS 65 item scores collected on admission must be available and valid For the overnight admitted episodes the 12 HoNOS 65 item scores are added to create a HONOS 65 total score for each episode The overnight episodes are split into two groups based on LOS The shorter stay episodes are then split into three groups based on the HONOS 65 item score for overactive behaviour Two of these groups are then split further one using the HONOS 65 ADL item score and the other using the HONOS 65 total score Non admitted psychogeriatric The record to be grouped to AN SNAP V4 should represent an episode of care This may require amalgamation of a series of service event records All HONOS 65 item scores collected on admission must be available and valid The 12 HONOS 65 item scores are added to create a HONOS 65 total score for each episode Assessment only records are split from the treatment r
16. meteor aihw gov au content index phtml itemld 498519 H The AROC impairment coding guidelines can be found at http ahsri uow edu au content groups public web chsd aroc documents doc uow125260 pdf AN SNAP V4 User Manual 52 CHSD centre for health service development Table 16 Impairment code map AROC Impairment Code When to use this group and or Aetiologic Diagnosis AN SNAP V4 definitions Paediatric Impairment Group 1 11 Stroke Haemorrhagic USE this group for cases with Intracerebral haemorrhage Brain Left Body Involvement Right the diagnosis of cerebral Other and unspecified Brain ischemia due to vascular intracranial haemorrhage 1 12 Stroke Haemorrhagic thrombosis embolism or Right Body Involvement Left haemorrhage Ischaemic strokes Brain that then have a haemorrhagic 1 13 Stroke Haemorrhagic event should be classified as Bilateral Involvement Stroke Ischaemic 1 14 Stroke haemorrhagic Do NOT use this group for No Paresis 1 cases of brain dysfunction 1 19 Stroke Haemorrhagic secondary to non vascular Other Stroke causes such as trauma inflammation tumour or degenerative changes 2 cases of subarachnoid haemorrhage These should be classified to Brain Dysfunction 2 11 1 21 Stroke Ischaemic Left USE this group for cases with Occlusion and stenosis of Brain Body Involvement Right Brain the diagnosis of cerebral precerebral arteries with 1 22 Stroke Ischaemic Right ischem
17. of Care Not Assessment Only Acute 4VA1 Focus of Care HoNOS 65 Total 0 8 Not Acute 4VN1 HoNOS 65 Total 9 13 4VN2 Overactive Behaviour HoNOS GR 14 Ly 0 1 gt AVN3 2 4 gt 4VN4 Table 14 Non admitted psychogeriatric classes 4VN3 Treatment Focus of Care not acute HONOS 65 total 14 48 HoNOS 65 Overactive behaviour 0 1 AVN4 Treatment Focus of Care not acute HONOS 65 total 14 48 HoNOS 65 Overactive behaviour 2 4 499V Non admitted Psychogeriatric Care Ungroupable AN SNAP V4 User Manual 42 CHSD centre for health service development APPENDIX 1 Definitions This Appendix provides definitions of variables and related concepts that underpin AN SNAP V4 The AN SNAP classification recognises that subacute services are provided in a specialised multidisciplinary context in which the primary need for care relates to the optimisation of the patient s functioning and quality of life This fundamental difference between acute care and subacute care gives rise to the need for an approach to subacute casemix classification that is not based primarily around patient diagnoses and procedures The definitions and concepts included here reflect this approach METeOR is Australia s repository for national metadata standards and definitions for the health community services and housing assistance sectors Where a nationally endorsed definition is available in METeOR it has been used and referenced in this Appendix S
18. or community setting In addition there are six error classes one for each of these sub branches and there is an overarching error class for episodes where valid care type and or episode type codes and or age are missing from the record AN SNAP V4 does not classify single discipline non admitted care It is expected that type of activity will be classified by the Tier 2 Classification In contrast the AN SNAP V4 non admitted classes are designed for episodes of multidisciplinary care Definitions of non admitted episode and multidisciplinary can be found in Appendix 1 Non admitted records that are not multidisciplinary will be allocated to an error class in AN SNAP V4 In the following pages the AN SNAP V4 non admitted classes are listed It should be noted that they contain few clinical variables This is because of the limitations of the data that were available for their development It is anticipated that these classes could be improved if episode level data with records that include accurate costs and clinical variables were to be available For this to happen there would need to be a considerable change to the current service event level non admitted data collections It is also anticipated that in future versions of AN SNAP same day subacute care activity will once again be grouped to the same classes that are appropriate for non admitted and community subacute activity This is because the type of care provided in a sam
19. repair of previous orthopaedic surgery Do NOT use this group when orthopaedic surgery is part of acute fracture management These should be classified to 8 111 8 19 USE this group for cases where the orthopaedic surgery involved the revision or repair of previous orthopaedic surgery Do NOT use this group when orthopaedic surgery is part of acute fracture management These should be classified to 8 111 8 19 Group includes jaw face rib orbit or Other sites not elsewhere classified excludes fracture associated with cerebral palsy classify to 3 5 or spinal cord impairment classify to 4 Psoriatic arthropathy Other Pyogenic arthritis Rheumatoid arthritis Juvenile chronic polyarthritis Chronic post rheumatic arthropathy Osteoarthritis and allied disorder Other and unspecified arthropathies Ankylosing spondylitis Mechanical complication of internal orthopedic device implant and graft Infection and inflammatory reaction due to internal orthopedic device implant and graft Other complications due to internal orthopedic or prosthetic device implant and graft Neoplasm of bone and articular cartilage Secondary neoplasm of bone Includes nerve root injury Other laminectomy spinal fusion discectomy Includes spinal deformity surgery Excludes spinal surgery associated with cerebral palsy classify as Neuro or spinal cord impairment classify as Spinal Excludes spinal cord caudaequ
20. sites where specialised rehabilitation is required for each of the impairments Do NOT use for multiple fractures These should be classified to Fracture of Multiple Sites 8 17 USE for trauma cases with complex management due to involvement of multiple systems or sites where specialised rehabilitation is required for each of the impairments Do NOT use for multiple fractures These should be classified to Fracture of Multiple Sites 8 17 14 1 Major Multiple Trauma Brain Spinal Cord Injury spinal cord caudaequina spinal nerve root major plexus or multiple roots 14 2 Major Multiple Trauma Brain Multiple Fracture Amputation 14 3 Major Multiple Trauma Spinal Cord spinal cord caudaequina spinal nerve root major plexus or multiple roots Multiple Fracture Amputation AN SNAP V4 User Manual USE for cases in which the major T o Spinal cord injury or disease Spinal cord injury or disease 62 CHSD centre for health service development AROC Impairment Code 14 9 Major Multiple Trauma Other Multiple Trauma 15 1 Developmental Disability 16 1 Reconditioning restorative following surgery 16 2 Reconditioning restorative following medical illness 16 3 Reconditioning restorative Cancer rehabilitation AN SNAP V4 User Manual When to use this group and or definitions USE for trauma cases with complex management due to involvement of multiple system
21. 0 839 0 910 0 955 0 828 1 577 1 492 1 077 0 717 1 084 0 924 1 282 1 330 2 5 The AN SNAP V4 class numbering system Impairment Group Stroke 1 007 1 054 1 018 0 645 Brain Dysfunction 1 512 0 941 0 783 0 286 Neuro Conditions 1 143 0 935 0 897 0 619 Spinal Cord Dys 0 924 0 926 0 233 1 098 Amp of Limb 1 218 0 700 0 747 2 709 Arthritis 0 761 1 161 0 763 0 593 Pain Syndromes 0 984 0 937 0 781 0 365 Ortho Cond Fract 0 934 0 935 0 828 0 528 Ortho Cond Repl Ortho Cond Other 1 184 1 013 0 668 0 485 1 184 1 013 0 668 0 485 Cardiac 0 984 0 937 0 781 0 365 Pulmonary 0 984 0 937 0 781 0 365 Burns 0 761 1 161 0 763 0 593 Congen Deform 0 761 1 161 0 763 0 593 Oth Disabling Imps 0 761 1 161 0 763 0 593 MMT 1 000 1 000 1 000 1 000 Devel Disabs 1 161 0 763 0 593 0 548 Reconditioning The previous convention of numbering the AN SNAP classes has been changed in Version 4 In earlier versions the first digit represents the version number the second digit represents the care type and the remaining two digits represent both the treatment setting and the specific class These final two digits were allocated to classes sequentially at the time of the version s release In Version 1 three digit codes were used with no leading digit to indicate the version number The new codes for AN SNAP V4 classes comprise four alphanumeric characters most of which represent a feature
22. 09 AN SNAP V4 User Manual 71 CHSD centre for health service development APPENDIX 3 The AN SNAP V4 four character numbering system NCCC Character 1 nom Jcotes osmon OOOO AN SNAP version Character 2 mem ces oser Care type and Adult rehabilitation treatment setting Adult palliative care overnight classes gt Adult geriatric evaluation and management Adult psychogeriatric care Adult non acute care Paediatric rehabilitation GO 11 mm UN DW Paediatric palliative care Adult rehabilitation Adult palliative care Care type and treatment setting same day classes Adult geriatric evaluation and management Adult psychogeriatric care Paediatric rehabilitation Paediatric palliative care Adult rehabilitation Adult palliative care Care type and treatment setting non admitted classes Adult geriatric evaluation and management Adult psychogeriatric care Paediatric rehabilitation J K L M O p S T U V X Y Paediatric palliative care Error class a Grouping variable missing AN SNAP V4 User Manual 72 CHSD centre for health service development Character 3 Applies to Information Codes Description coded Adult rehab classes Stroke Brain Dysfunction Neurological Conditions Spinal Cord Dysfunction Amputation of Limb Arthritis Pain Syndromes Orthopaedic Conditions Fracture Orthopaedic Conditions Replacement Orthopaedic Cond
23. 1 class 4K01 Paediatric Age lt 17 Palliative Care Overnight 4 classes 4G Same Day 1 class 4P01 GEM GEM Overnight 6 classes 4C Same Day 1 class 4L01 Psychogeriatric l Psychogeriatric Overnight 6 classes 4D Same Day 1 class 4M01 Non acute l Non Admitted Ambulatory 35 classes Non acute 6 classes 4E Rehabilitation Adult Age gt 18 Rehabilitation 8 classes 4S Paediatric Age lt 17 Rehabilitation 5 classes 4X Palliative Care Adult Age gt 18 Palliative Care 8 classes 4T ro fo Paediatric Age lt 17 Palliative Care 4 classes 4Y GEM GEM 4 classes 4U Psychogeriatric Psychogeriatric 6 classes 4V AN SNAP V4 User Manual 10 CHSD centre for health service development 2 2 1 Splitting the admitted and non admitted branches Consistent with previous versions each of the two overarching branches is split by care type and subsequently by other variables In the admitted branch there are classes for palliative care phases and rehabilitation GEM psychogeriatric and non acute episodes Non acute was formerly called maintenance A further refinement in AN SNAP V4 is the order in which the care ty
24. 3 18 All other impairments Age lt 64 Stroke weighted FIM motor 51 91 FIM cognition 29 35 Stroke weighted FIM motor 51 91 FIM cognition 19 28 Stroke weighted FIM motor 51 91 FIM cognition 5 18 Stroke weighted FIM motor 36 50 Age gt 68 Stroke weighted FIM motor 36 50 Age lt 67 Stroke weighted FIM motor 19 35 Age gt 68 Stroke weighted FIM motor 19 35 Age lt 67 Brain dysfunction weighted FIM motor 71 91 FIM cognition 26 35 Brain dysfunction weighted FIM motor 71 91 FIM cognition 5 25 Brain dysfunction weighted FIM motor 41 70 FIM cognition 26 35 Brain dysfunction weighted FIM motor 41 70 FIM cognition 17 25 Brain dysfunction weighted FIM motor 41 70 FIM cognition 5 16 Brain dysfunction weighted FIM motor 29 40 Brain dysfunction weighted FIM motor 19 28 Neurological conditions weighted FIM motor 62 91 Neurological conditions weighted FIM motor 43 61 Neurological conditions weighted FIM motor 19 42 Spinal cord dysfunction Age gt 50 weighted FIM motor 42 91 Spinal cord dysfunction Age gt 50 weighted FIM motor 19 Spinal cord dysfunction Age lt 49 weighted FIM motor 34 91 Spinal cord dysfunction Age lt 49 weighted FIM motor 19 Amputation of limb Age gt 54 weighted FIM motor 68 91 Amputation of limb Age 54 weighted FIM motor 31 67 Amputation of limb Age 54 weighted FIM motor 19 30 Amputation of limb Age lt 53 weighted FIM motor 19 91 Orthopaedic conditi
25. 33 Palliative care phase start The palliative care phase commencement date is the date on which an admitted palliative care patient commences a new palliative care phase type Subsequent phase begin dates are equal to the previous phase end date Ref METeOR ID 445848 Palliative care phase end The palliative care phase end date is the date on which an admitted palliative care patient completes a palliative care phase type Ref METeOR ID 445598 Age For the purposes of assignment to an AN SNAP class age is defined at the age of a person on the first day of a subacute or non acute episode Ref METeOR ID 303794 Age type For assignment to an AN SNAP class the variable Age Type is an indicator variable coded as 1 Paediatric 2 Adult 9 Missing not stated that determines whether a rehabilitation or palliative care episode is assigned to an adult or paediatric AN SNAP class If this variable takes a value of 1 or 2 it will override Age as the variable to select the adult or paediatric AN SNAP class This variable is optional and is valid for patients aged between 16 and 19 inclusive only Episode length of stay For the purposes of assignment to an AN SNAP class the length of stay of an admitted episode is the length of stay of the episode excluding leave days measured in days Ref METeOR ID 269422 For the purposes of assignment to an AN SNAP class the length of stay of a non admitted episode is the numb
26. 4 14 Deteriorating 4BD1 Age gt 75 gt 4BD2 RUG ADL 15 18 m 55 74 gt 4BD3 lt 54 gt 4BD4 Phase Type Terminal 4BT1 Table 4 Admitted adult palliative care classes 4BU4 Unstable phase Not first Phase in Episode RUG ADL 6 18 AN SNAP V4 User Manual 31 CHSD centre for health service development Figure 5 Admitted paediatric palliative care branch Admitted Admitted Paediatric Palliative Care Paediatric Age lt 17 Ungroupable Palliative Care 499G Same Day 4P01 Phase Type Age lt 1 Overnight Not Terminal 4G01 Phase Type Age gt 1 Stable 4G02 Phase Type Unstable or Deteriorating 4603 Phase Type Terminal 4604 Table 5 Admitted paediatric palliative care classes 4G04 Palliative Care Terminal phase 4P01 Paediatric Same Day Palliative Care 499G Paediatric Overnight Palliative Care Ungroupable AN SNAP V4 User Manual 32 CHSD centre for health service development Figure 6 Admitted GEM branch Admitted Admitted GEM GEM Ungroupable 499C Same Day 4 01 Delirium or Dementia Overnight FIM Motor 57 91 gt With gt 4CH1 Without gt 4CH2 Delirium or Dementia FIM Motor 18 56 gt With gt 4CM1 Without gt 4CM2 Delirium or Dementia FIM Motor 13 17 gt With gt 4CL1 Witho
27. AP V4 there are 70 classes for rehabilitation specifically 50 admitted adult overnight classes 5 admitted paediatric overnight classes 2 admitted same day classes one for adult and one for paediatric care 8non admitted adult classes and 5 non admitted paediatric classes The variables used to define the rehabilitation classes include impairment age or Age Type FIM cognition score a weighted FIM motor score and in the non admitted setting assessment only Details of the impairment specific weights are presented in Section 2 4 Impairment is defined by the AROC Impairment Codes Version 4 Impairment groups that are used in the paediatric classes brain dysfunction neurological conditions spinal cord dysfunction and other are combinations of these codes Definitions of age and assessment only are provided in Appendix 1 The AROC impairment codes with a map to the adult and paediatric impairment groups as well as the FIM items AN SNAP V4 User Manual 13 CHSD centre for health service development and scores are provided in Appendix 2 Further details on these clinical assessment tools can be found in the AROC data dictionary 2 3 2 Palliative care In AN SNAP V4 there are 30 classes for palliative care specifically 12 admitted adult overnight classes 4admitted paediatric overnight classes 2 admitted same day classes one for adult and one for paedi
28. CHSD centre for health service development The Australian National Subacute and Non acute Patient Classification AN SNAP V4 User Manual May 2015 aiken n t ahsri UNIVERSITY OF 233 australian health services WOLLONGONG ME research institute pe CHSD centre for health service development Janette Green Rob Gordon Conrad Kobel Megan Blanchard Kathy Eagar Suggested Citation Green J Gordon R Kobel C Blanchard M and Eagar K 2015 AN SNAP V4 User Manual Centre for Health Service Development University of Wollongong CHSD centre for health service development Acknowledgements The Australian National Subacute and Non acute Patient Classification Version 4 AN SNAP V4 has been developed by the Centre for Health Service Development University of Wollongong on behalf of the Independent Hospital Pricing Authority Centre for Health Service Development Team members Janette Green Rob Gordon Kathy Eagar Megan Blanchard Conrad Kobel External Clinical Project Team Members Richard Chye Jan Erven Penny Ireland Lynne McKinlay Chris Poulos Support from the Independent Hospital Pricing Authority and in particular Ms Joanne Fitzgerald and Ms Caroline Coevoet in the preparation of this User Manual is gratefully appreciated AN SNAP V4 User Manual 1 CHSD centre for health service development Contents MMM 1 NNN 2 ROT 4 OT Se vacsanite quanav E E A E E E A 4 Ce EE
29. Care not acute HoNOS 65 total 14 48 yenge HoNOS 65 Overactive behaviour 0 1 l Er Treatment Focus of Care not acute HONOS 65 total 14 48 AVN4 Non admitted Psychogeriatric HONOS 65 Overactive behaviour 2 4 499V Non admitted Psychogeriatric Non admitted Psychogeriatric Care Ungroupable AN SNAP V4 User Manual 78
30. E E tested ie aa eee 5 LNR 6 CL CONTON A E EN meena O 6 1 2 Progressive development of the AN SNAP classification ccccccsssecceccesseeceeeeeceseeeeees 6 2 The AN SNAP V4classifiCatiO M esiseina NKE E EEEE AA EEN N TAE 8 2 1 Summary of changes from AN SNAP V3 eeeeseeessreresseersssreresrreresrerosseeressreressreresseresseeress 8 2 2 Structure Of AN SNAP V4 spaiiasacitontedstatictexeutedcnisndiurstein nir A aai 9 2 2 1 Splitting the admitted and non admitted branches rrrrannrrnnnnnrrnnnnnnrrnnnnnnernnnnneree 11 222 PENG 11 ZZ ENO CAS SCS weincws conscience sh saint vaslennin EEE 12 2 3 Variables used in AN SNAP V4 ccssccccssseccccceseccesesseceseesecceeaaescessegeeeesseneceesageeeessageses 12 Pode NNN 13 Ze PAN VECI E EEE AAE 14 25 NN 14 POA POPE 15 255 NNN 15 2 4 Weighting the FIM item scores in the admitted rehabilitation classes orrrrsrnemne 15 2 5 The AN SNAP V4 class numbering SyStem rrrrannrrrnnnnrrrnnnnnnrrnnnnerrnnnnnerrnnnnnnsrnnnnnsnennnnee 16 3 Grouping episodes phases to AN SNAP V4 rvrvrnrnrrnnnnrnrnnnnrnvnrnrnnnrrvrnnrnrnrnrrrrvrrrnrrrnrerersrnrnene 18 3 4 Variables used for BLOUDING vicsisessnsisincssadsiaiadendeoadoushieates siedeeastenatsavoncuanserskiasauseneateaniwerese 18 32 VON 19 33 Thegroupinge PROCESS guuosnsntmvukmsem drm NANDE EEA NENESE RETE ERS 19 3 3 1 Treatment setting and Care type Splits r rrrrnnnnnornrnnnnrrrnnnnerrnnnnnernnnnnnrrnnnnnernnnnnneeee 19 3 3 2
31. IN U U UD wo ee es UD PD IP P P gt P gt N N N Q m AIWWJNJ re mS W N a WINTER INTO UT gt W N e M UlR VUVINIH gt N e A gt Episode Type Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation Admitted Adult Rehabilitation N SNAP V4 User Manual The AN SNAP V4 Classification Description Weighted FIM motor score 13 18 Brain Spine MMT Age 49 Weighted FIM motor score 13 18 Brain Spine MMT Age lt D 00 Weighted FIM motor score 13 18 All other impairments Age 2 65 Weighted FIM motor score 1
32. N SNAP V4 Section 2 2 Grouping of same day activity at the level of day rather than episode of care Section 2 2 A change in the order in which the care type sub branches are listed within the admitted and non admitted branches of the classification to be consistent with national definitions Section 2 2 1 A change in the name of the maintenance care type to non acute Section 2 2 1 The introduction of paediatric classes for the palliative care rehabilitation and non acute care types Section 2 2 2 The introduction of a variable Age Type that can be used in rehabilitation and palliative care to override age in determining whether an episode phase is grouped to a paediatric or adult class Section 2 2 2 The removal of assessment only classes from the admitted branch of the classification Section 2 3 The introduction of impairment specific weights to Functional Independence Measure FIM item scores in the calculation of a motor score in the admitted rehabilitation branch of AN SNAP V4 Sections 2 3 and 2 4 The introduction of a derived variable first phase in the episode in the admitted palliative care classes Section 2 3 The removal of the bereavement class from admitted and non admitted palliative care branches of AN SNAP V4 Section 2 3 AN SNAP V4 User Manual 8 CHSD centre for health service development The introduction of delirium and deme
33. NM Motor Stroke W FIM Motor 51 91 gt 19 W FIM Motor 36 50 W FIM Motor 19 35 Brain 6 W FIM Motor 71 91 Dysfunction W FIM Motor 41 70 W FIM Motor 29 40 4AB6 W FIM Motor 19 28 4AB7 Neurological 2 91 gt 4AC1 Conditions 13 61 gt 4AC2 Spinal Cord Dysfunction Amputation of Limb 4AE4 AN SNAP V4 User Manual 26 CHSD centre for health service development Admitted Adult Age 2 18 Rehabilitation Orthopaedic Fractures W FIM Motor 49 91 W FIM Motor 38 48 4AH3 W FIM Motor 19 37 4AH4 Orthopaedic All Other Cardiac Pain Syndromes Pulmonary MMT 4AP1 Reconditioning W FIM Motor 67 91 4AR1 W FIM Motor 50 66 W FIM Motor 34 49 W FIM Motor 19 33 4AR6 All Other Impair AN SNAP V4 User Manual 27 CHSD centre for health service development Table 2 Admitted adult rehabilitation classes 4AA5 Stroke weighted FIM motor 36 50 Age lt 67 4AA6 Stroke weighted FIM motor 19 35 Age gt 68 4AA3 Stroke weighted FIM motor 51 91 FIM cognition 5 18 4AA7 Stroke weighted FIM motor 19 35 Age lt 67 4AA4 Stroke weighted FIM motor 36 50 Age gt 68 4AH3 Orthopaedic conditions fractures weighted FIM motor 38 48 4AH4 Orthopaedic conditions fra
34. Non Acute Patient Classification AN SNAP report of the National Subacute and Non Acute Casemix Classification Study Centre for Health Service Development University of Wollongong AN SNAP V4 User Manual 6 CHSD centre for health service development subacute care gives rise to the need for an approach to subacute casemix classification that is not based primarily around patient diagnoses and procedures AN SNAP V1 comprised 134 classes across five care types 66 overnight admitted and 68 ambulatory and explained 58 of the variance in episode costs In 2007 CHSD completed a review of AN SNAP V1 on behalf of the NSW Department of Health which led to the development of AN SNAP V2 The scope of the AN SNAP V2 review was limited to the overnight admitted branch of the classification and focussed on the palliative care and rehabilitation care types AN SNAP V2 comprised 151 classes 83 overnight admitted and 68 ambulatory More recently CHSD released AN SNAP V3 which incorporated some minor changes including the deletion of one overnight maintenance care class AN SNAP V3 comprised 82 overnight admitted classes and 68 ambulatory classes This manual describes AN SNAP V4 Findings from the literature advice provided in the context of meetings and other consultations with stakeholders and statistical analysis of the available data all fed into the development of AN SNAP V4 The primary source of data for the development of AN SNAP V4 w
35. Post pneumonia Emphysema Asthma Bronchiectasis Pulmonary insufficiency following trauma surgery Other Spinal cord injury or disease Spina Bifida 61 CHSD centre for health service development AROC Impairment Code When to use this group and or definitions USE for cases in which the purpose of this rehabilitation episode is to address an anomaly or deformity of the musculoskeletal system that has been present since birth DO NOT use this group for other congenital anomalies of nervous system These should be classified to 3 9 12 9 Congenital deformities Other AN SNAP V4 Paediatric Impairment Group Aetiologic Diagnosis Arthrogryposis Osteochondrodysplasias Osteogenesis imperfecta 13 1 Other disabling e USE for cases in which the major Other impairments Lymphoedema disorder is lymphoedema 13 3 Other disabling impairments Conversion Disorder 13 9 Other disabling impairments Other disorder is conversion disorder USE for cases that cannot be classified into any other impairment group This group should be rarely used USE for trauma cases with complex management due to involvement of multiple systems or sites where specialised rehabilitation is required for each of the impairments Do NOT use for multiple fractures These should be classified to Fracture of Multiple Sites 8 17 USE for trauma cases with complex management due to involvement of multiple systems or
36. alitis AN SNAP V4 User Manual 53 CHSD centre for health service development AROC Impairment Code When to use this group and or definitions 2 21 Traumatic Brain Dysfunction open injury USE this group for cases with motor and or cognitive disorder secondary to brain trauma 2 22 Traumatic Brain Dysfunction closed injury USE this group for cases with motor and or cognitive disorder secondary to brain trauma DEFINITION A closed head injury is defined as an injury where the meninges remain intact includes a linear fracture of the skull AN SNAP V4 Paediatric Aetiologic Diagnosis Impairment Group e Chronic Fatigue Syndrome e Toxic encephalopathy Skull fracture Brain Cerebral laceration and contusion with open intracranial wound Subarachnoid subdural extradural and other unspecified haemorrhage following injury Other and unspecified intracranial haemorrhage following injury Linear skull fracture Concussion Cerebral laceration and contusion Subarachnoid subdural extradural and other unspecified haemorrhage following injury Other and unspecified intracranial haemorrhage following injury Brain 3 1 Neurologic Conditions e Multiple Sclerosis Brain Multiple Sclerosis 3 2 Neurologic Conditions e Parkinsonism Brain Parkinsonism 3 3 Neurologic Conditions Polyneuropathy Hereditary and idiopathic Neuro peripheral neuropathy Peripheral neuropathy inflammatory
37. as the public sector Round 16 2011 12 of the National Hospital Cost Data Collection NHCDC The contents and coverage of this dataset were limited as outlined in the report describing the development of the classification In an attempt to develop a more comprehensive dataset for analysis the NHCDC data were supplemented with additional data as follows Records in the Palliative Care Outcomes Collaboration PCOC dataset were matched to NHCDC inpatient palliative care records to expand the geographic coverage of the data available for class finding for the admitted overnight palliative care branch of AN SNAP V4 Records in the Australasian Rehabilitation Outcomes Centre AROC dataset were matched to NHCDC inpatient rehabilitation records to expand the geographic coverage of the data available for class finding for the admitted overnight rehabilitation branch of AN SNAP V4 Paediatric subacute care datasets were provided by several facilities as there were insufficient variables included in the paediatric episodes in the NHCDC Data additional to that in the NHCDC were provided to the project team directly from some jurisdictions As a result of matching AROC and PCOC data to the NHCDC records the number of jurisdictions represented in the initial palliative care dataset increased from two to seven and the number of jurisdictions represented in the initial rehabilitation dataset increased from two to six It should be noted how
38. atric care 8non admitted adult classes and 4non admitted paediatric classes The variables used to define the admitted palliative care classes include palliative care phase the total score on the Resource Utilisation Groups Activities of Daily Living RUG ADL tool age or Age Type and a derived variable first phase in episode which distinguishes a phase at the beginning of an episode from the subsequent phases of a palliative care episode The total score on the Palliative Care Problem Severity Score PCPSS is also used in the definition of some non admitted palliative care classes It should be noted that although there are no longer any AN SNAP classes for the bereavement phase this remains an important component of palliative care including that provided to paediatric patients and their families and carers Definitions of age and first phase in episode are in Appendix 1 The codesets for the clinical tools palliative care phase RUG ADL and PCPSS are provided in Appendix 2 Further details on these clinical assessment tools can be found in the PCOC clinical manual and the PCOC data dictionary 2 3 3 GEM In AN SNAP V4 there are 11 classes for GEM specifically 6 admitted overnight classes 1admitted same day class and 4Anon admitted classes The variables used to define the admitted GEM classes are the FIM motor score the sum of the first 13 items of the FIM tool and ICD 10 AM diagnosis deme
39. ctures weighted FIM motor 19 37 4A21 Orthopaedic conditions all other including replacements weighted FIM motor 68 91 AN SNAP V4 User Manual 28 CHSD centre for health service development AN SNAP V4 User Manual 29 CHSD centre for health service development Figure 3 Admitted paediatric rehabilitation branch Admitted Admitted Paediatric Rehabilitation Paediatric Age lt 17 Ungroupable Rehabilitation 499F Same Day 4001 Age lt 3 Overnight AFO1 Impairment Code Group Spinal Cord Dysfunction gt 4F02 Age 2 4 gt Brain Dysfunction gt 4F03 Neurological Conditions gt 4F04 All Other Impairments gt 4F05 Table 3 Admitted paediatric rehabilitation classes AN SNAP V4 User Manual 30 CHSD centre for health service development Figure 4 Admitted adult palliative care branch Admitted Admitted Adult Palliative Care Adult Age 2 18 Ungroupable Palliative Care 499B Same Day 4K01 RUG ADL f Phase Type 4 5 gt 4BS1 SRA Stable 6 16 gt 4BS2 17 18 gt 4BS3 oe RUG ADL eg First Phase in Episode gt 4 13 gt 4BU1 14 18 gt 4BU2 RUG ADL NOT First Phase in Episode gt 4 5 gt 4BU3 6 18 gt 4BU4 Phase Type RUG ADL
40. ding fear of leaving home crowds public places travelling social phobias and specific phobias Anxiety and panics Obsessional and compulsive problems Reactions to severely stressful events and traumas m Dissociative conversion problems F Somatisation Persisting physical complaints in spite of full investigation and i reassurance that no disease is present 1 Sexualproblems S AN SNAP V4 User Manual 68 CHSD centre for health service development Gu 1 Palliative care phase The palliative care phase identifies a clinically meaningful period in a patient s condition The palliative care phase is determined by a holistic clinical assessment which considers the needs of the patients and their family and carers There are five phases in the palliative care phase assessment Stable Unstable Deteriorating BR WwW N e Terminal 5 Bereaved post death support The fifth phase bereaved is not used in AN SNAP V4 More details and the phase assignment algorithm can be found in the PCOC clinical manual 19 METeOR Palliative care phase web page can be found at http meteor aihw gov au content index phtml itemld 445942 17 PCOC clinical manual can be found at http ahsri uow edu au content groups public web chsd coc documents doc uow129133 pdf AN SNAP V4 User Manual 69 CHSD centre for health service development Palliative Care Problem Severity Scores PCPSS The Palliati
41. e available and valid For the overnight admitted episodes a weighted FIM motor score is calculated by firstly multiplying each FIM item score by the corresponding weight for the impairment group of the record The impairment group is derived from the AROC Impairment Code as shown in Appendix 2 These numbers are then added to create a weighted FIM motor score which is rounded to the nearest integer for class assignment The five FIM cognition item scores are added to create a FIM cognition score for each episode An impairment group is assigned to each record based on the AROC impairment code as described in Appendix 2 The overnight admitted episodes are grouped using the weighted FIM motor score into a lower function and a higher function group each of which is subsequently split by impairment group Allimpairment groups except for MMT are then split using a combination of the weighted FIM motor score the FIM cognition score and age to create the AN SNAP V4 classes Non admitted adult rehabilitation The record to be grouped to AN SNAP V4 should represent an episode of care This may require amalgamation of a series of service event records An impairment group is assigned to each record based on the AROC impairment code as described in Appendix 2 Assessment only records are split from the treatment records into a single class The treatment group is then split on the impairment group reco
42. e day admitted setting is equivalent to that provided in a non admitted setting Whether the patient is admitted or not is driven primarily by differences in local admission policies In relation to non admitted paediatric rehabilitation and palliative care the non admitted classes in AN SNAP V4 are the same as those in the admitted branch AN SNAP V4 User Manual 36 CHSD centre for health service development Figure 9 Non admitted adult rehabilitation branch Non Admitted Adult Age 2 18 Rehabilitation Assessment Only 4SY1 Not Assessment Only Non Admitted Adult Rehabilitation Ungroupable 499S Stroke 4SA1 Brain Dysfunction 4SB1 Spinal Cord Dysfunction 4SD1 Pain Syndromes 4SG1 Orthopaedic Conditions 4S11 Cardiac 4SK1 All Other Impairments 4591 Table 9 Non admitted adult rehabilitation classes AN SNAP V4 User Manual 37 CHSD centre for health service development Figure 10 Non admitted paediatric rehabilitation branch Non Admitted Non Admitted Paediatric Rehabilitation Paediatric Age lt 17 Ungroupable Rehabilitation 499X Age lt 3 4X01 Impairment Code Group Spinal Cord Dysfunction gt 4X02 Age 2 4 Brain Dysfunction gt 4X03 Neurological Conditions gt 4X04 All Other Impairments gt 4X05 Table 10 Non admitt
43. ecords into a single class The treatment group is then split using the variable Focus of Care The HoNOS 65 total score is used to split the not acute Focus of Care group into three AN SNAP V4 User Manual 22 CHSD centre for health service development The group with the highest HONOS 65 total score is split further using the HONOS 65 overactive behaviour item score Admitted non acute All RUG ADL item scores collected on admission must be available and valid The four RUG ADL item scores are added to create a RUG ADL total score for each episode The episodes are split into two groups based on LOS The shorter stay episodes are then split into three groups based on the patient s age The group with the older patients is then split further into three groups using RUG ADL Error classes If at any step in the care type grouping process described above a variable is missing or invalid the episode phase will be assigned to the error class for the relevant care type treatment setting combination It should be noted that some clinical tools include an option for not assessed If this score is used the total cannot be calculated and the record would be assigned to an error class 3 4 Other factors that may affect grouping Subacute and non acute care data collection processes and protocols should be consistently applied to any records that are to be grouped to AN SNAP As mentioned previously care ty
44. ed paediatric rehabilitation classes 4X01 Rehabilitation Age lt 3 4X02 Rehabilitation Age 4 Spinal cord dysfunction 4X03 Rehabilitation Age 4 Brain dysfunction 4X04 Rehabilitation Age 4 Neurological conditions 4X05 Rehabilitation Age 4 All other impairments 499X Paediatric Non admitted Rehabilitation Ungroupable AN SNAP V4 User Manual 38 CHSD centre for health service development Figure 11 Non admitted adult palliative care branch Non Admitted Non Admitted Adult Palliative Care Adult Age 2 18 Ungroupable Palliative Care 499T Phase Type Stable 4TS1 eae PCPSS seg RUG ADL 4 gt 0 7 gt 4TU1 8 12 gt 4TU2 RUG ADL 5 18 4TU3 Phase Type PCPSS 0 6 Deteriorating 4TD1 RUG ADL PCPSS 7 12 gt 4 10 gt 4TD2 11 18 gt 4TD3 Phase Type Terminal 4TT1 Table 11 Non admitted adult palliative care classes Code Description de kode 4TD1 Deteriorating phase PCPSS 0 6 4TD2 Deteriorating phase PCPSS 7 12 RUG ADL 4 10 4TD3 Deteriorating phase PCPSS 7 12 RUG ADL 11 18 4TT1 Terminal phase 499T Adult Non admitted Palliative Care Ungroupable AN SNAP V4 User Manual 39 CHSD centre for health service development Figure 12 Non admitted paediatric palliative care
45. episode Palliative care adult classes palliative care phase functional independence measured by the RUG ADL tool a flag to indicate that the record is the first phase in the patient s episode patient age Age Type and for non admitted care the PCPSS collected at the beginning of the episode Palliative care paediatric classes palliative care phase and patient age Age Type collected at the beginning of the episode GEM functional independence measured by the motor subscale of the FIM collected at the beginning of the episode as well as a flag to indicate that delirium or dementia were included amongst the diagnoses in the episode record Psychogeriatric function measured by the HoNOS 65 and LOS as well as for non admitted care Focus of Care collected at the beginning of the episode and assessment only and Non acute age and functional independence measured by the RUG ADL collected at the beginning of the episode and LOS AN SNAP V4 User Manual 18 CHSD centre for health service development 3 2 Unit of counting A casemix classification is an algorithm that groups encounters with the health system into clinically meaningful and resource homogeneous classes These classifications can be designed to group single days of care phases of care episodes of care or episodes of illness This unit of counting needs to be represented by each record in the data file that is to be grouped In AN SNAP V4
46. er Manual 50 CHSD centre for health service development APPENDIX 2 Clinical tools used to define AN SNAP V4 classes In the following pages codesets of the clinical tools used to define AN SNAP V4 classes are listed All scores are collected at the start of the episode or for palliative care at the start of the phase The tools included are AROC Impairment Codes Function Independence Measure FIM Focus of Care Health of the Nation Outcome Scale HONOS 65 Palliative care phase Palliative Care Problem Severity Score PCPSS Resource Utilisation Groups Activities of Daily Living RUG ADL AN SNAP V4 User Manual 51 CHSD centre for health service development AROC Impairment Codes An impairment code should be assigned to reflect the primary reason for the current episode of rehabilitation care Rehabilitation program names relating to funding are not necessarily the same as the impairment group names To determine the AN SNAP V4 Adult Impairment Group the AROC impairment coding guidelines must be used to determine the impairment code The impairment code should be truncated to get the impairment integer for impairments other than Orthopaedic e g 3 9 truncates to 3 For Orthopaedic impairments the impairment code should be truncated to one decimal place e g 8 231 truncates to 8 2 The table below maps the truncated AROC Impairment Code and group name to the AN SNAP V4 Adult Impa
47. er of days on which the patient is treated during that episode Same day admitted care Same day admitted care is care provided to a same day patient who is admitted and separated from the hospital on the same date Ref METeOR ID 373961 AN SNAP V4 User Manual 49 CHSD centre for health service development Long term care For the purposes of assignment to AN SNAP V4 classes 4DL1 Long term care admitted psychogeriatric and 4EL1 Long term care admitted non acute care long term care class is defined as an episode of subacute care with a length of stay greater than or equal to 92 days First phase in palliative care episode For the purposes of assignment to the admitted palliative care AN SNAP V4 classes the term first phase in episode applies when an unstable phase is the first phase in an admitted palliative care episode The corresponding term not first phase in episode applies when an unstable phase is the second or subsequent phase of an admitted palliative care episode GEM clinic For the purposes of assignment to the non admitted GEM AN SNAP V4 classes the definition of falls clinic memory clinic and other clinic is a subacute geriatric evaluation and management examination consultation treatment or other service provided in a non admitted setting in a specialty unit or under an organisational arrangement administered by a hospital Derived from METeOR ID 336980 AN SNAP V4 Us
48. esigned to group subacute and non acute episodes or palliative care phases provided in admitted overnight admitted same day non admitted and community settings Relevant terms such as episode start are defined in Appendix 1 and details of the clinical assessment tools used in the classification are provided in Appendix 2 3 1 Variables used for grouping A number of variables are required for a patient record to group successfully to a class in AN SNAP V4 It is assumed that a subacute or non acute care type has been assigned to the data according to the established protocol All records to be grouped to AN SNAP V4 must include the variables episode type to differentiate between admitted and non admitted settings care type and for rehabilitation and palliative care age or Age Type see Section 2 2 2 for a detailed explanation of how the variable Age Type is applied in AN SNAP V4 Non admitted records must include a flag to indicate that the episode was multidisciplinary Other variables that are required are specific to the care type assigned to the record The required variables are Rehabilitation adult classes AROC impairment group functional independence measured by the cognitive and weighted motor subscales of the FIM and patient age Age Type all collected at the beginning of the episode Rehabilitation paediatric classes paediatric impairment group and patient age Age Type collected at the beginning of the
49. ever that the number of records from some jurisdictions was limited gt Green J Gordon R Blanchard M Kobel C and Eagar K 2014 Op cit AN SNAP V4 User Manual 7 CHSD centre for health service development 2 The AN SNAP V4 classification The AN SNAP V4 classification has 130 classes 124 for subacute and 6 for non acute care Amongst the subacute classes are 83 for overnight admitted episodes phases 6 for same day admissions and 35 for non admitted episodes phases There is also an error class for each care type and treatment setting combination and an overarching error class for episodes where valid care type and or episode type codes and or for rehabilitation and palliative care Age Type and age are missing from the record A list of all classes is provided at the end of this manual in Appendix 4 2 1 Summary of changes from AN SNAP V3 AN SNAP V4 introduces a number of changes from previous versions Details are provided below In summary the key changes are A change in the description of the two major branches of AN SNAP V4 from overnight admitted and ambulatory to admitted and non admitted reflecting the setting in which the care is provided Section 2 2 The inclusion of six same day admitted classes one for each of adult rehabilitation paediatric rehabilitation adult palliative care paediatric palliative care GEM and psychogeriatric care types in the admitted branches of A
50. ew If an episode of subacute care doesn t meet the above definition then it is single discipline care and should be excluded from AN SNAP AN SNAP Care type definitions AN SNAP includes four subacute care types rehabilitation palliative care geriatric evaluation and management and psychogeriatric care and one non acute care type non acute care formerly called maintenance care The definition of each care type is shown below The initial development and subsequent implementation of AN SNAP has involved the application of a care type hierarchy in which episodes are assigned firstly to the palliative care care type and subsequently to rehabilitation psychogeriatric GEM and non acute care types in that order The purpose of this hierarchy is to clarify situations where there is any confusion about the appropriate care type to be assigned There has been more recent national work on the subacute and non acute care type definitions These definitions emphasise the requirement of basing the care type assignment decision on the primary clinical purpose or treatment goal of the care being provided This should preclude the need for a care type assignment hierarchy in AN SNAP V4 Rehabilitation care Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an impairment activity limitation or participation restriction due to a health
51. exception was made where there were too few episodes of Major Multiple Trauma MMT to develop a Australian Mental Health Outcomes and Classification Network website http amhocn org AN SNAP V4 User Manual 15 CHSD centre for health service development reliable set of weights The item weights for MMT episodes were therefore all set at 1 In other words for MMT an unweighted FIM motor score is used The derived weights are presented in Table 1 The weights are multiplied by the corresponding item scores and the total is rounded to the nearest integer for assigning the episode to a class It should be noted that the FIM motor score used in the GEM classes is the unweighted sum as it has been in previous versions of AN SNAP Table 1 Impairment specific FIM item weights for overnight rehabilitation classes 0 983 1 028 1 058 0 835 1 121 1 145 1 348 1 060 1 021 1 039 0 925 0 972 1 239 0 817 1 082 0 787 1 132 1 278 0 803 0 843 1 246 0 810 1 137 1 465 0 831 0 624 1 027 0 400 1 290 0 974 0 839 0 910 0 955 0 828 1 577 1 492 1 016 0 687 1 108 0 751 1 416 1 461 0 903 0 707 1 053 1 100 1 405 1 332 0 872 0 809 1 081 0 998 1 400 1 317 0 872 0 809 1 081 0 998 1 400 1 317 1 016 0 687 1 108 0 751 1 416 1 461 1 016 0 687 1 108 0 751 1 416 1 461 0 839 0 910 0 955 0 828 1 577 1 492 0 839 0 910 0 955 0 828 1 577 1 492 0 839 0 910 0 955 0 828 1 577 1 492 1 000 1 000 1 000 1 000 1 000 1 000 0 761
52. h spinal cord injury hemiarthroplasty is part of the classify to 14 3 fracture treatment AN SNAP V4 User Manual 59 CHSD centre for health service development AROC Impairment Code When to use this group and or definitions Aetiologic Diagnosis AN SNAP V4 Paediatric Impairment 8 19 Orthopaedic Fracture Other 8 211 Post Orthopaedic Surgery Unilateral hip replacement 8 212 Post Orthopaedic Surgery Bilateral hip replacement 8 221 Post Orthopaedic Surgery Unilateral knee replacement 8 222 Post Orthopaedic Surgery Bilateral knee replacement 8 231 Post Orthopaedic Surgery Knee and hip replacement same side 8 232 Post Orthopaedic Surgery Knee and hip replacement different sides 8 24 Post Orthopaedic Surgery Shoulder replacement or repair 8 25 Post Orthopaedic Surgery spinal 8 26 Post Orthopaedic Surgery Other USE this group for cases in which the major disorder is post fracture of bone or post e arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment USE this group for cases where e the orthopaedic surgery e involved the revision or repair of e previous orthopaedic surgery Do NOT use this group when e orthopaedic surgery is part of acute fracture management These should be classified to 8 111 8 19 USE this group for cases where the orthopaedic surgery involved the revision or
53. his group for cases in which the major disorder is post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment Aetiologic Diagnosis Osteoarthritis and allied disorders Psoriatic arthropathy Scleroderma Systemic lupus erythematosus Systemic sclerosis Dermatomyositis Polymyositis Pyogenic arthritis Other and unspecified arthropathies Fibromyalgia Ankylosing spondylitis Various aetiologies includes NOF includes NOF AN SNAP V4 Paediatric Impairment Group Other Other Other Other Other 58 CHSD centre for health service development AROC Impairment Code When to use this group and or Aetiologic Diagnosis AN SNAP V4 definitions Paediatric Impairment Group 8 12 Orthopaedic Fracture USE this group for cases in excludes femur involving knee shaft of femur which the major disorder is joint post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 13 Orthopaedic Fracture USE this group for cases in pelvis which the major disorder is post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 141 Orthopaedic Fracture USE this group for cases in includes patella femur knee which the
54. ia due to vascular cerebral infarction Body Involvement Left Brain thrombosis embolism or Occlusion of cerebral arteries 1 23 Stroke Ischaemic haemorrhage Ischaemic strokes with cerebral infarction Bilateral Involvement that then have a haemorrhagic 1 24 Stroke Ischaemic No event should be classified as Paresis Stroke Ischaemic 1 29 Stroke Ischaemic Other Do NOT use this group for Stroke 1 cases of brain dysfunction secondary to non vascular causes such as trauma inflammation tumour or degenerative changes 2 cases of subarachnoid haemorrhage These should be classified to Brain Dysfunction 2 11 2 11 Non Traumatic Brain USE this group of cases with Non traumatic spontaneous Brain Dysfunction subarachnoid such aetiologies as neoplasm berry aneurysm haemorrhage including metastases Anoxic brain damage Anoxic 2 12 Non Traumatic Brain encephalitis inflammation hypoxic encephalopathy Dysfunction Anoxic brain anoxia metabolic toxicity or Encephalitis damage degenerative processes Meningitis 2 13 Non Traumatic Brain Do NOT use this group for cases Neoplasm tumour of brain or Dysfunction Other with hemorrhagic stroke other meninges malignant or than subarachnoid benign includes secondary haemorrhage These should be tumours classified to Stroke Neoplasm tumour of cranial Haemorrhagic 1 1 nerves Intracranial abscess Hydrocephalus Acute demyelinating encephalomyelitis ADEM Anti NMDAR enceph
55. iated with medical conditions related to ageing such as tendency to fall incontinence reduced mobility and cognitive impairment The patient may also have complex psychosocial problems Geriatric evaluation and management is always delivered under the management of or informed by a clinician with specialised expertise in geriatric evaluation and management and evidenced by an individualised multidisciplinary management plan which is documented in the patient s medical record that covers the physical psychological emotional and social needs of the patient and includes negotiated goals within indicative time frames and formal assessment of functional ability Ref METeOR ID 491557 Psychogeriatric care Psychogeriatric care is care in which the primary clinical purpose or treatment goal is improvement in the functional status behaviour and or quality of life for an older patient with AN SNAP V4 User Manual 45 CHSD centre for health service development significant psychiatric or behavioural disturbance caused by mental illness an age related organic brain impairment or a physical condition Psychogeriatric care is always delivered under the management of or informed by a clinician with specialised expertise in psychogeriatric care and evidenced by an individualised multidisciplinary management plan which is documented in the patient s medical record that covers the physical psychological emotional and
56. ill require the formulation of business rules that provide appropriate solutions to such issues AN SNAP V4 User Manual 24 CHSD centre for health service development 4 The AN SNAP V4 admitted classes The admitted branch of AN SNAP V4 comprises 83 overnight admitted and 6 same day subacute classes as well as 6 non acute classes There is also an error class for each care type and there is an overarching error class for episodes where valid care type and or episode type codes and or age are missing from the record The name of the maintenance care type has been changed to non acute Some derived variables from existing collections such as first phase of episode in palliative care and diagnoses of dementia and delirium in the GEM classes have been introduced In rehabilitation a weighted sum of FIM motor items replaces the unweighted total previously used AN SNAP V4 User Manual 25 CHSD centre for health service development Figure 2 Admitted adult rehabilitation branch Admitted Admitted Adult Rehabilitation Adult Age gt 18 Ungroupable Rehabilitation 499A Same Day 4JO1 Brain Dysf Overnight MA SE Spinal Cord Dysf MMT All Other Impair
57. ina major nerve root dysfunction classify to 4 Other and unspecified Other disorders of joint Pathologic fracture requiring surgical intervention Excludes pathologic fracture in context of spinal cord dysfunction or cerebral palsy Osteotomy Bone Lengthening 8 3 Soft Tissue Injury USE this group for cases where Severe sprains ligament tears Other there has been significant soft rotator cuff tears AN SNAP V4 User Manual 60 CHSD centre for health service development AROC Impairment Code When to use this group and or definitions AN SNAP V4 Paediatric Impairment Aetiologic Diagnosis 9 1 Cardiac disorders following recent onset of new cardiac impairment 9 2 Cardiac disorders Chronic cardiac insufficiency 9 3 Cardiac disorders Heart or heart lung transplant 10 1 Pulmonary Disorders Chronic Obstructive Pulmonary Disease 10 2 Pulmonary Disorders Lung Transplant 10 9 Pulmonary Disorders Other Pulmonary Disorders 11 Burns 12 1 Congenital deformities Spina Bifida AN SNAP V4 User Manual tissue injuries requiring rehabilitation but no fracture DO NOT use this group for cases where there is a fracture in addition to soft tissue injuries These should be classified to 8 111 8 19 USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to cardiac insufficiency or general deconditioning due to cardiac dis
58. ine AN SNAP V4 classes rrrrnnnrrrnnnnnrrnnnnnnrrnnnnnerrnnnnnerne 51 AROC Impairment COGS senkes 52 Functional Independence Measure FIM c ccccccsssseccscecescecescecscescecescscsececacescaseceecaceesaceaeaes 64 FOCU OT CMe EEE ENE 66 Health of the Nation Outcome Scale HONOS 65 4 ccccccssssceceeesecceeesecceeeeeeceseeeeeeeeeeeeeeeeees 67 PEN 69 Palliative Care Problem Severity Scores PCPSS rrrrrnrnnnnrrnnnnnnnrrnnnnnvrnnnnnrnnnnnnnernnnnnnennnnnnnennnne 70 Resource Utilisation Group Activities of Daily Living RUG ADL rerrrnrrerrrrrnnnrrrnnnnnrrnnnvnerennnne 71 APPENDIX 3 The AN SNAP V4 four character numbering system NCCC rrrrrrrrrnrnnnnrrrnrnnnn 72 APPENDIX 4 The AN SNAP V4 Classification ccccccsssccccceseececeessceceaesceceseeeceeseessceeeeaecessnees 75 AN SNAP V4 User Manual 3 CHSD centre for health service development List of Tables Table 1 Impairment specific FIM item weights for overnight rehabilitation classes 16 Table 2 Admitted adult rehabilitation classes rrrnrrurrnnnnrrnnnnrrnrnnvrnnnnevnnnnennnnnnrnnnnssnnnnnennnnenee 28 Table 3 Admitted paediatric rehabilitation classes rrrrrnnrrnnnnrrnrnnrrnnnnrrnnnnrrnrnnnrnnnnevnnnnsvnnnnenee 30 Table 4 Admitted adult palliative care classes rrrrnrrnrrnnnnrrnrnnrrnrnnnrnnnnevnnnnernnnnernnnnsrnnnnnennnnenee 31 Table 5 Admitted paediatric palliative care classes rrrrrnrrrnnnnrrnrnnvrnnnnnrnnnnernrnnn
59. injury without evidence of spinal bone injury Spinal cord dysfunction resulting from surgical misadventure Neoplasm of bones or cartilage and other soft tissue of limb Secondary neoplasm of bone Diabetes with neurologic manifestations or diabetes with peripheral circulatory disorders Hereditary and idiopathic peripheral neuropathy Inflammatory and toxic neuropathy Atherosclerosis of the extremities Peripheral vascular disease unspecified Arterial embolism and thrombosis extremities Buerger s disease Acquired deformity or injury affecting limbs Aneurysm of extremities Amputation stump complication revision Haemangioma Vasculitis eg scleroderma SLE DIC eg meningococcus Connective tissue disorders 56 CHSD centre for health service development AROC Impairment Code 5 18 Non Traumatic Amputation Of Limb Partial Foot Amputation includes single double 5 19 Non Traumatic Amputation Of Limb Other Amputation 5 21 Traumatic Amputation Of Limb Single Upper Amputation Above the Elbow 5 22 Traumatic Amputation Of Limb Single Upper Amputation Below the Elbow 5 23 Traumatic Amputation Of Limb Single Lower Amputation Above the Knee includes through the knee 5 24 Traumatic Amputation Of Limb Single Lower Amputation Below the Knee 5 25 Traumatic Amputation Of Limb Double Lower Amputation Above the Knee includes through the knee 5 26 Traumatic Amputation Of Limb Double Lowe
60. irment Group split by weighted FIM motor score on admission Table 15 Impairment groups Truncated AROC AROC Impairment Code AN SNAP V4 Adult Impairment AN SNAP V4 Adult Impairment Impairment Code Group Name Group Weighted FIM Motor Group Weighted FIM motor Admission 13 18 admission 19 91 1 Stroke All Other Impairments Stroke _ _ O 2 Brain Dysfunction Brain Dysfunction Brain Dysfunction _ 8 Neurological All Other Impairments Neurological ____ 4 Spinal Cord Dysfunction Spinal Cord Dysfunction Spinal Cord Dysfunction 5 Amputation Of Limb All Other Impairments Amputation Of Limb _ Pp 6 Arthritis All Other Impairments All Other Impairments 7 Pain Syndromes All Other Impairments Cardiac Pain Syndromes Pulmonary Orthopaedic Fractures All Other Impairments Orthopaedic Fractures Orthopaedic Post Surgery All Other Impairments Orthopaedic All Other Orthopaedic Soft Tissue Injury All Other Impairments Orthopaedic All Other Cardiac disorders All Other Impairments Pulmonary 10 Pulmonary Disorders All Other Impairments Pulmonary A preliminary map between the AROC Impairment Codes and the AN SNAP V4 paediatric impairment groups has been developed It is presented in the following table with examples of aetiologic diseases that underpin each impairment and some guidelines around their use 10 METeOR Episode of admitted patient care primary impairment type code web page http
61. is rated Ratings reflect both the degree of distress the problem causes and the effect it has on behaviour Specifically the items are Table 19 HoNOS 65 items 3 Problem drinking or drug taking w 4 Jcogniiveproblems O OOOO 5 Physical illness or disability problems 6 Problems associated with hallucinations and delusions 8 Other mental and behavioural problems 9 Problems with relationships S Each item is rated on a five point item of severity 0 to 4 as follows Table 20 HoNOS 65 scores Score peseripion 0 No problem within the periodrated SSS i minor problem requiring no formal action SCSC S 2 mild problem Should be recorded in a care plan or other case record Problem of moderate severity A Severe to very severe problem a Not stated Missing 14 METeOR Level of psychiatric symptom severity HONOS 65 score web page car be found at http meteor aihw gov au content index phtml itemld 449363 AMHCON HONOS 65 glossary can be found at http amhocn org static files assets ad3f087e HoNOS65 Glossary pdf AN SNAP V4 User Manual 67 CHSD centre for health service development 9 Unable to rate because not known or not applicable to the consumer Additional information about the type or kind of problem rated in Item 8 is also included in the tool as Item 8A The options are Table 21 HoNOS 65 Item 8A additional information Phobias inclu
62. ith respect to late loss activities those activities that are likely to be lost last in life bed mobility toileting transfers and eating and is used to assess the level of functional dependence based on what a person actually does rather than what they are capable of doing Each of the four items measures an aspect of motor function with scoring options as shown in the following table AN SNAP V4 uses the sum of all four items collected at the beginning of the episode phase to group the patient s episode phase If any item has been scored 9 Not assessed the total is not calculated and the episode phase groups to an error class Table 23 RUG ADL items and scores Item Code Bed Mobility Independent or supervision only Limited physical assistance Other than two persons physical assist Two person or more physical assist Not assessed Toileting Independent or supervision only Limited physical assistance Other than two persons physical assist Two person or more physical assist Not assessed Transfer Independent or supervision only Limited physical assistance Other than two persons physical assist Two person or more physical assist Not assessed Eating Independent or supervision only Limited assistance Extensive assistance total dependence tube fed Not assessed 1 METeOR Resource Utilisation Groups Activities of Daily Living web page car be found at http meteor aihw gov au content index phtml itemld 4959
63. itions Other Cardiac Pulmonary Burns Congenital Deformities Other Disabling Impairments Major Multiple Trauma Developmental Disabilities Reconditioning Single impairment All orthopaedic conditions Orthopaedic conditions replacement and other Cardiac pain and pulmonary Other impairments Assessment only PY Assessment only Low function z Weighted FIM motor lt 18 Adult palliative care Palliative care Stable phase classes phase Unstable phase Deteriorating phase Terminal phase Paediaricclasses 0 SOS Admitted GEM classes Motor function FIM motor 13 17 FIM motor 18 56 FIM motor 57 97 Non admitted GEM Clinic type C Clinic type classes Admitted Length of stay L LOS 92 days psychogeriatric and S LOS lt 91 days non acute classes Non admitted Focus of care A Acute psychogeriatric N Non acute classes same daycasses 012 SSS Error classes Ungroupable 9 Grouping variable missing a code is included for each impairment group although some impairments are grouped together and their individual code is not used in V4 Impairment group OWNPIDOWOZALH r 7 ION1mM00060 gt NI lt OCA I Z m AN SNAP V4 User Manual 73 CHSD centre for health service development Character 4 item codes Description SSCS Sub group number Sequential numbering of classes after the first split O lt XxX lt M C 41404 0d TD MUN 0 ld ld Error classes
64. l clinical purpose of the care changes and the patient no longer meets the criteria for classification to that care type or the patient is formally separated from the hospital Non admitted patient A non admitted patient is a person who does not undergo a hospital s formal admission process Non admitted patients may be treated in outpatient community and domiciliary settings by either hospital or community health agencies AN SNAP V4 User Manual 47 CHSD centre for health service development Episode of non admitted patient care An episode of non admitted subacute care is a sequence of subacute care provided to a person who receives care in an outpatient or community setting An episode of non admitted subacute care consists of one or more occasions of service or service events Episode start non admitted subacute care An episode of non admitted subacute care begins when the patient is seen either face to face or via another means by a member of the clinical team and when there is documented evidence in a medical record that the person meets the criteria for subacute care In the event that these occur on different days the episode of care begins on the day when the medical record is documented Episode end non admitted subacute care An episode of non admitted subacute care ends when either the principal clinical purpose of the care changes and the patient no longer meets the criteria for classification
65. ls can be found on the Australian Mental Health Outcomes and Classification Network website It is not known if psychogeriatric activity will continue to be classified by AN SNAP after Version 4 At the time of development of AN SNAP V4 the classification of mental health care in Australia was also being reviewed Psychogeriatric classes may be incorporated into the new mental health classification when it is developed 2 3 5 Non acute care In AN SNAP V4 there are six non acute formerly called maintenance classes all of which sit within the admitted branch They are used for grouping paediatric as well as adult patient episodes The variables used to define these classes are LOS total RUG ADL score and age or Age Type Age Age Type and LOS are defined in Appendix 1 and the RUG ADL codeset is provided in Appendix 2 2 4 Weighting the FIM item scores in the admitted rehabilitation classes In all previous versions of AN SNAP the FIM motor score has been used as a splitting variable It is calculated as the unweighted sum of the 13 motor items in the FIM instrument In AN SNAP V4 a weighted FIM motor score has been used to define admitted rehabilitation classes using a set of impairment specific weights that reflect the relative impact of each item on the cost of caring for the rehabilitation patient Where impairments are grouped together in the classification a single set of weights for that group has been derived An
66. major disorder is involving knee joint tibia or post fracture of bone or post fibula involving knee joint arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 142 Orthopaedic Fracture USE this group for cases in lower leg ankle foot which the major disorder is post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 15 Orthopaedic Fracture USE this group for cases in includes hand fingers wrist upper limb which the major disorder is forearm arm shoulder post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 16 Fracture of spine USE this group for cases in excludes where the major which the major disorder is disorder is pain post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment 8 17 Orthopaedic Fracture USE this group for cases in multiple bones of same lower multiple sites which the major disorder is limb both lower limbs lower post fracture of bone or post with upper limb lower limb arthroplasty joint replacement with rib or sternum Excludes USE when joint replacement with brain injury classify to arthroplasty or 14 2 or wit
67. n 2012 IHPA established a Subacute Care Working Group SCWG as part of a broader committee structure to develop approaches to the ongoing classification and costing of subacute care activities undertaken within public hospital services The SCWG includes representatives from each Australian jurisdiction the private sector and major subacute care clinical bodies The commissioning of the current project represents an important element in establishing the infrastructure to support the ongoing implementation of a subacute and non acute ABF model 1 2 Progressive development of the AN SNAP classification AN SNAP V1 was developed as a casemix classification for subacute and non acute patients in a national study conducted by CHSD in 1997 That study established the existence of an underlying episode based classification for subacute and non acute care provided in overnight admitted same day admitted non admitted and community settings The five AN SNAP care types recognise that subacute services are provided in a specialised multidisciplinary context in which the primary need for care relates to the optimisation of the patient s functioning and quality of life This fundamental difference between acute care and Green J Gordon R Blanchard M Kobel C and Eagar K 2014 Development of AN SNAP Version 4 Final Report Centre for Health Service Development University of Wollongong Eagar K et al 1997 The Australian National Subacute and
68. nations adult rehabilitation paediatric rehabilitation adult palliative care paediatric palliative care GEM psychogeriatric and non acute In the non admitted branch there are six error classes one for each of the care type age combinations adult rehabilitation paediatric rehabilitation adult palliative care paediatric palliative care GEM and psychogeriatric 2 3 Variables used in AN SNAP V4 There have been very few changes to the variables required for grouping episodes phases in AN SNAP V4 with the majority of variables being available on admission There are two situations where required variables will not be available until the end of an episode Firstly in the admitted GEM branch of the classification diagnoses of delirium and dementia have been introduced as grouping variables These diagnoses are coded using the International Statistical Classification of Diseases and Related Health Problems Tenth Revision Australian Modification ICD 10 AM after the episode has ended Secondly as was the case in AN SNAP V3 episode length of stay is required to assign an AN SNAP class for non acute and psychogeriatric episodes In the admitted branch the variables used for grouping are Care type characteristics of the person and the goal of treatment Function motor and cognition on admission all care types Phase stage of illness palliative care Impairment rehabilitation Behaviour psychogeriatric AN
69. nd the definitions of phase could be revised to incorporate the concept of complex vs stable patient and to better reflect the impact of the bereavement phase amongst this cohort of patients Including the same day classes there are six paediatric rehabilitation classes five paediatric palliative care classes and one non acute paediatric class in the admitted branch of AN SNAP V4 The paediatric rehabilitation and palliative care overnight admitted classes are duplicated in the non admitted branch Future versions of AN SNAP may include different paediatric classes in the non admitted branch for these care types if subsequent collections of data show that to be appropriate The single non acute paediatric class is defined by age This class sits logically within the adult non acute branch of AN SNAP However the paediatric rehabilitation and palliative care classes are distinct from the equivalent adult classes For this reason they have been located separately but following the respective adult classes This means that for these two care types the first split after setting admitted vs non admitted is based on age lt 17 or 218 years However in clearly defined circumstances the use of precisely 17 or younger to allocate a paediatric class can be overridden In a small number of circumstances it may be decided to group patients younger than 18 to an adult class or patients older than 17 to a paediatric class AN SNAP V4 User
70. nnnnneee 38 Figure 11 Non admitted adult palliative care branch rrarrrrnnnnnrrrnnnnnnrrnrnnnrrnnnnnnernnnnnesrnsnneee 39 Figure 12 Non admitted paediatric palliative care branch rarrrrnnnnnnrrnnnnnnrrnnnnnrrnnnnnnernnnnnneee 40 Figure 13 Non dmitt d GEM br ndhauuaussnssmuansmnika maskenanneskdnidsuniee 41 Figure 14 Non admitted psychogeriatric branch rrrarnrnnnnnnrrnnnnnnnrrnnnnernnnnnnernnnnnsnvrnnnnessnnnenee 42 AN SNAP V4 User Manual 4 CHSD centre for health service development Glossary ABF ADL AHSRI AIHW AN SNAP AROC CHSD DSS FIM GEM HoNOS ICD 10 AM IHPA LOS MMT NHCDC NHDD PCOC PCPSS RUG ADL SCWG Activity based funding Activity of daily living Australian Health Services Research Institute Australian Institute of Health and Welfare Australian National Subacute and Non acute Patient Classification Australasian Rehabilitation Outcomes Centre Centre for Health Service Development Data Set Specification Functional Independence Measure Geriatric Evaluation and Management Health of the Nation Outcome Scale The International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification Independent Hospital Pricing Authority Length of stay Major Multiple Trauma National Hospital Cost Data Collection National Health Data Dictionary Palliative Care Outcomes Collaboration Palliative Care Problem Severity Score Resource Utilisa
71. nnnnnernnnnennnnenee 32 Table6 Admitted GEM classes dasiisedecscncesscssosndetvwnnsasatdacurcswontiadoacdondtucdoasaiinwaneniettdedidarsendeses 33 Table 7 Admitted psychogeriatric classes rrrrrrrnrrurnnnnnnrnnnnnrnnnnnrnnnnnnnnnnnvnnnnnvnnnnnsnnnnnnennnnnennnnnene 34 Tables Admitted non acute ClaSSOS cat icc csceccvasisenccedencesesaowsarindecsnedesuscesadsabiadawseanidawsaneesanibeades 35 Table 9 Non admitted adult rehabilitation classes rrrrnrrrnrnnnrrrnrnnnrrnnnnnerrnrnnnrrnnnnnnernnnnnesennnn 37 Table 10 Non admitted paediatric rehabilitation classes rrrrurrrnnnrrnnnnnrnnnnnrnnnnnrrnrnnernnnneennnnene 38 Table 11 Non admitted adult palliative care ClaSSeS rrrnrnnrrnnnnrrnnnnnrnnnnnrnnnnnrnnnnnrnrnnsvnnnnsnnnnnesne 39 Table 12 Non admitted paediatric palliative care ClaSSeS rrrrrnrannrrnnnnnrrnnnnnnernnnnnerrnnnnnssnnnnnee 40 Table13 Non admitted GEM Classe ccisscssassacccsvactcusisecasenneteasscnsescedesmereeasanaiananadaasoodeuseneesnio ones 41 Table 14 Non admitted psychogeriatric ClaSSeS rrrrrnannnrnnnnnnrrnnnnnnrrnnnnnnrnnnnnnernnnnnnvrnnnnnssennnnee 42 DER h pvr 52 Table 16 Impairment code map rrrrnnnnnnnnnnnrrrnnnnnrvnnnnnnernnnnnnernnnnnernnnnseerennnseernnnnnssennnnsesennnsssesnne 53 Table 17 FIM items 64 Table 18 FIM item Scores c cccecessecescesescescsceecsceesaceccacsecsecaesesacsecaeeasacsecsecacsesaceesacsucaesecaeeasenees 65 TET NS 67 Table 20 HONOS OST SCOLES Lee ease Spa IAE EEr IE
72. ntia and delirium In the Relevant definitions found in the AROC Data dictionary http ahsri uow edu au aroc onlinedd index html gt PCOC clinical manual can be found at http ahsri uow edu au content groups public web chsd pcoc documents doc uow129133 pdf 6 ese PCOC data dictionary can be found at http ahsri uow edu au content groups public web chsd pcoc documents doc uow126175 pdf AN SNAP V4 User Manual 14 CHSD centre for health service development non admitted branch there is one GEM class for a single day of care without an ongoing care plan and three other classes based on clinical programs Definitions of GEM clinic and single day of care without ongoing care plan are provided in Appendix 1 The FIM items and scores are provided in Appendix 2 2 3 4 Psychogeriatric care In AN SNAP V4 there are 13 psychogeriatric classes specifically 6 admitted overnight classes 1admitted same day class and 6non admitted classes The variables used to define the psychogeriatric classes are LOS and scores on the Health of the Nation Outcome Scale HONOS 65 In the non admitted psychogeriatric classes assessment only and the clinical tool Focus of Care are also used for grouping A definition of assessment only and long term care are provided in Appendix 1 The codesets of the clinical tools HONOS 65 and Focus of Care are provided in Appendix 2 Further details on these clinical assessment too
73. ntia diagnoses as variables in the admitted GEM classes Section 2 3 The removal of FIM cognition from the admitted GEM branch Section 2 3 Minor refinement to the positioning of age and clinical splits in the admitted branches of AN SNAP V4 The removal of non admitted non acute maintenance classes Section 2 3 The removal of the FIM clinical tool from the rehabilitation and GEM non admitted branches of AN SNAP V4 Section 2 3 The removal of single discipline classes from the non admitted branches of AN SNAP V4 The introduction of a four character alpha numeric codeset for AN SNAP V4 classes Section 2 5 2 2 Structure of AN SNAP V4 Previous versions of AN SNAP comprised two main branches one for overnight admitted episodes phases and the second for ambulatory episodes phases provided in same day admitted non admitted and community settings In AN SNAP V4 the structure of the classification has been modified to be consistent with current data collection processes and terminology The structure of AN SNAP V4 can be seen in Figure 1 and definitions of relevant concepts are provided in Appendix 1 In AN SNAP V4 there are again two overarching branches The first includes admitted patient episodes both overnight and same day and the second non admitted episodes outpatients and community A consequence of this modification is that the same day classes represent a single day rather than a sequence or
74. ntre for health service development gt i Memory Table 18 FIM item scores AN SNAP V4 User Manual 65 CHSD centre for health service development 1 Focus of Care Focus of Care is rated retrospectively Clinicians are asked to identify which of one of four types of care focus best describes the primary goal of care provided to a consumer over the period preceding the Collection Occasion 1 Acute where the primary goal is the short term reduction in severity of symptoms and or personal distress associated with the recent onset or exacerbation of a psychiatric disorder 2 Functional gain where the primary goal is to improve personal social or occupational functioning or promote psychosocial adaptation in a patient with impairment arising from a psychiatric disorder 3 Intensive extended where the primary goal is prevention or minimisation of further deterioration and reduction of risk of harm in a patient who has a stable pattern of severe symptoms frequent relapses or severe inability to function independently and is judged to require care over an indefinite period 4 Maintenance where the primary goal is to maintain the level of functioning minimise deterioration or prevent relapse where the patient has stabilised and functions relatively independently 9 Not stated Missing It is recognised that all of these aspects may be found in the mental health care of any particular consumer But the concep
75. of the care or the splitting variable used to allocate the class The first character is the version number while character two is alpha and depicts the care type and treatment setting The third character is selected from a codeset that is related to the specific care type and setting and the final character is determined by sequential numbering Details of the AN SNAP V4 class nomenclature are provided in Appendix 3 AN SNAP V4 User Manual 16 CHSD centre for health service development The codes break with another AN SNAP tradition in the way that they depict care types In previous versions the care types have been coded 1 5 for palliative care rehabilitation psychogeriatric care GEM and maintenance respectively to reflect the hierarchy of care type assignment used in previous version of AN SNAP These codes are not the same as those assigned in the national admitted patient data collection and the NHCDC As AN SNAP becomes a national collection it is timely to address this discrepancy As an interim measure and to avoid confusion for those who have used previous versions of AN SNAP the care types for V4 are indicated by alpha characters in the class code In future versions of AN SNAP this could be changed to numeric codes that align with the other national collections AN SNAP V4 User Manual 17 CHSD centre for health service development 3 Grouping episodes phases to AN SNAP V4 The AN SNAP V4 classification is d
76. on Above the Knee includes through the knee 5 14 Non Traumatic Amputation Of Limb Single Lower Amputation Below the Knee 5 15 Non Traumatic Amputation Of Limb Double Lower Amputation Above the Knee includes through the knee 5 16 Non Traumatic Amputation Of Limb Double Lower Amputation Above Below the Knee 5 17 Non Traumatic Amputation Of Limb Double Lower Amputation Below the Knee AN SNAP V4 User Manual When to use this group and or definitions USE this group for cases with quadriplegia paresis and paraplegia paresis secondary to trauma accident injury Do NOT use this group for post spinal surgery unless the surgery has resulted in dysfunction of the spinal cord caudaequina A detailed coding guideline for patients with spinal cord injury disease and damage is contained in the appendix to assist in the coding of patients It is suggested that this be reviewed when considering patients with these conditions to ensure the most accurate code relevant for patient is used USE this group for cases in which the major deficit is partial or complete absence of a limb not resulting from a trauma Aetiologic Diagnosis AN SNAP V4 Paediatric Impairment Group congenital condition eg spina bifida cerebral palsy Cerebral Palsy with Selective Dorsal Rhizotomy if deficits include new weakness Spinal cord injury or disease Fracture of vertebral column with spinal cord injury Spinal cord
77. ons fractures weighted FIM motor 49 91 FIM cognition 33 35 Orthopaedic conditions fractures weighted FIM motor 49 91 FIM cognition 5 32 Orthopaedic conditions fractures weighted FIM motor 38 48 Orthopaedic conditions fractures weighted FIM motor 19 37 WwW P W me 75 CHSD centre for health service development Si Pain syndromes Pulmonary weighted FIM motor lhe Pain syndromes Pulmonary weighted FIM motor a Pain syndromes Pulmonary weighted FIM motor a Pain syndromes Pulmonary weighted FIM motor 4AP1 Admitted Adult Rehabilitation Major Multiple Trauma weighted FIM motor 19 91 4AR1 Admitted Adult Rehabilitation Reconditioning weighted FIM motor 67 91 oe weighted FIM motor 50 66 FIM cognition oe weighted FIM motor 34 49 FIM cognition AN SNAP V4 User Manual 76 CHSD centre for health service development HoN i haviour 1 2 HoN ADL 4 4DS2 Admitted Psychogeriatric ONOS 65 Overactive behaviour 1 2 HONOS 65 LOS lt 91 HoNOS 65 O tive behaviour 1 2 HONOS 65 ADL 0 3 4DS3 Admitted Psychogeriatric Velactive DenaVinur O LOS lt 91 HoN i havi HoN total 18 4 ADS4 Admitted Psychogeriatric ONOS 65 Overactive behaviour 0 HONOS 65 total 18 48 LOS lt 91 HoN i havi HoN total 0 17 ADSS Admitted Psychogeriatric pe Overactive behaviour 0 HONOS 65 total 0 17 AN SNAP V4 User Manual 77 CHSD centre for health service development rn Se ee Treatment Focus of
78. order USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to cardiac insufficiency or general deconditioning due to cardiac disorder USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to cardiac insufficiency or general deconditioning due to cardiac disorder USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to pulmonary insufficiency USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to pulmonary insufficiency USE for cases in which the purpose of this rehabilitation episode is to address poor activity tolerance secondary to pulmonary insufficiency USE for cases in which the purpose of this rehabilitation episode is to address burns to major areas of skin and or underlying tissue USE for cases in which the purpose of this rehabilitation episode is to address Spina Bifida Group Rhabdomyolysis Severe crush injuries Falls resulting in severe soft tissue injury but no fractures Acute myocardial infarction Other Cardiac myopathy Post cardiac surgery Coronary atherosclerosis Other Ischemic heart disease Heart failure Congenital heart disease Cardiac myopath Other Chronic obstructive Other pulmonary disease Other Chronic bronchitis Other
79. pe sub branches are listed within the admitted and non admitted branches of the classification In previous versions of AN SNAP the care types have been listed in order of an assignment hierarchy of subacute and non acute care types namely palliative care followed by rehabilitation followed by psychogeriatric followed by GEM followed by non acute formerly called maintenance This hierarchy should no longer be required following a revision of the national care type definitions see Appendix 1 to among other things clarify the basis of care type assignment In AN SNAP V4 the order in which the care types are listed has been modified in accordance with the care type codes assigned within the national data collections such as the Admitted Patient Care Minimum Data Set This is to follow the logic of the assigned codes 2 2 2 Paediatric classes An important refinement in AN SNAP V4 is the introduction of paediatric classes for the palliative care rehabilitation and non acute care types These classes are very much a first version and are based on clinical tools that are currently used for adults Future refinement of these classes may include the development of paediatric specific tools as well as changes to the class definitions as additional data become available In particular a refined set of impairment groups could be developed for paediatric rehabilitation patients For paediatric palliative care patients the AN SNAP classes a
80. pes should be assigned according to an established protocol This includes the timing of care type changes There needs to be a consistent approach to the assignment of subacute and non acute care types In previous versions of AN SNAP this was underpinned by a prescribed hierarchy However recent national work has been completed in which these care type definitions have been revised to include among other things an emphasis on the basis of the care type decision being the primary clinical purpose or treatment goal of the care provided This should preclude the need for a care type assignment hierarchy in AN SNAP V4 Palliative care is grouped at the level of phase which is a subset of an episode Protocols for phase changes should be consistently applied When patients are assessed routinely clinicians will identify a change in the patient s needs or a change in the family or carer needs impacting on the patient s care This will trigger a phase change Phase assignment algorithm is detailed in the PCOC clinical manual There are no palliative care classes in AN SNAP V4 for the bereavement phase However this continues to be an important component of palliative care There is a distinction between PCOC clinical manual can be found at http ahsri uow edu au content groups public web chsd pcoc documents doc uow129133 pdf AN SNAP V4 User Manual 23 CHSD centre for health service development immediate post death sup
81. port which follows from the death of a patient and ongoing bereavement counselling which would be classified as care provided to the individual receiving support There has been ongoing debate about recognition of immediate post death support of family and carers particularly when the classification is to be applied in a funding context It is noted that there are some inconsistencies between providers in models of care and treatment settings of some programs For example some services operate entirely under a consultation liaison model of care Another example is in paediatric care where many same day admitted rehabilitation programs are clinically equivalent to those provided in an overnight admitted setting On the other hand some services provide same day admitted care that is similar to care provided by other services in a non admitted setting To some extent issues such as these can be accommodated in a casemix classification For example in previous versions of AN SNAP same day admitted care was classified with non admitted activity to allow for the similarity in the programs that are provided in both settings However a casemix Classification does not stand alone It is often more appropriate to deal with some issues that affect grouping via a well articulated set of business rules around the classification and by funding models that ensure that payment is fairly allocated to equivalent types of care The implementation of AN SNAP V4 w
82. r Amputation Above Below the Knee 5 27 Traumatic Amputation Of Limb Double Lower Amputation Below the Knee 5 28 Traumatic Amputation Of Limb Partial Foot Amputation includes single double 5 29 Traumatic Amputation Of Limb Other Amputation 6 1 Arthritis Rheumatoid arthritis AN SNAP V4 User Manual When to use this group and or definitions USE this group for cases in which the major deficit is partial or complete absence of a limb resulting from a trauma USE this group for cases in which the major disorder is rheumatoid arthritis Do NOT use for cases entering rehabilitation immediately after joint replacement even if the procedure was performed secondary to arthritis These should be classified to Post Orthopaedic Surgery 8 211 8 26 Aetiologic Diagnosis Gangrene Infective processes eg osteomyelitis cellulitis Burns with amputation Congenital limb loss developmental therapy ina child Congenital limb loss with conversion amputation Congenital limb loss when prosthesis required Traumatic amputation complete partial Rheumatoid arthritis Juvenile chronic polyarthritis Chronic post rheumatic arthropathy AN SNAP V4 Paediatric Impairment Group Other Other 57 CHSD centre for health service development AROC Impairment Code 6 2 Arthritis Osteoarthritis 6 9 Arthritis Other 7 1 Pain Syndromes Neck Pain 7 2 Pain Syndromes Back Pain 7 3 Pain Syndromes Ex
83. rd Dysfunction Quadriplegia Complete C5 8 4 13 Non Traumatic Spinal Cord Dysfunction Other AN SNAP V4 User Manual When to use this group and or definitions USE this group for cases with quadriplegia paresis and paraplegia paresis of non traumatic i e medical or post operative origin Do NOT use this group for post spinal surgery unless the surgery has resulted in dysfunction of the spinal cord caudaequina A detailed coding guideline for patients with spinal cord injury disease and damage is contained in the appendix to assist in the coding of patients It is suggested that this be reviewed when considering patients with these conditions to ensure the most accurate code relevant for patient is used Aetiologic Diagnosis AN SNAP V4 Paediatric Impairment Group Other extrapyramidal disease and abnormal movement disorders Spinocerebellar disease Disorders of the autonomic nervous system Following procedure in person with Rett Syndrome Other demyelinating diseases of the central nervous system Congenital anomalies of nervous system other than those classified to 12 9 Tuberculosis infective processes involving the vertebral column Neoplasm tumour of spinal column or spinal meninges malignant or benign includes secondary tumours Neoplasm of other parts of nervous system of unspecified nature Transverse myelitis Intraspinal or paraspinal abscess Dissection of aorta Aortic aneurysm rupt
84. rded for the episode AN SNAP V4 User Manual 20 CHSD centre for health service development Admitted and non admitted paediatric rehabilitation Inthe admitted branch same day records are split from the overnight records into a single class Episodes where the patient s age on admission is three or less are split into a single class Episodes where the patient s age is four years or more are then split into paediatric impairment groups as shown in Appendix 2 Admitted adult palliative care Same day records are split from the overnight records into a single class All RUG ADL item scores collected on admission must be available and valid For the overnight admitted episodes RUG ADL item scores are added to create a RUG ADL total score that is used for grouping The overnight admitted episodes are split into four groups based on palliative care phase Three of the phase groups are then split using one or more of the variables RUG ADL total score a flag indicating that the phase is the first phase of an episode and age Non admitted adult palliative care The record to be grouped to AN SNAP V4 should represent an episode of care This may require amalgamation of a series of service event records All RUG ADL and PCPSS item scores collected on admission must be available and valid For the non admitted episodes RUG ADL item scores are added to create a RUG ADL total score that is used for grouping
85. s or sites where specialised rehabilitation is required for each of the impairments Do NOT use for multiple fractures These should be classified to Fracture of Multiple Sites 8 17 USE for patients who have significant intellectual disabilities mental retardation Do NOT use for cases of cerebral palsy These should be classified to Cerebral Palsy 3 5 USE for cases with generalized deconditioning not attributable to any of the other Impairment Groups eg where deconditioning is due toa cardiac disorder classify as 9 2 where deconditioning is due to pulmonary insufficiency classify as 10 2 USE for cases with generalized deconditioning as a result of cancer or treatment for cancer Excludes brain tumours which are Classified as Brain Aetiologic Diagnosis Muscular wasting and disuse atrophy not elsewhere classified Unspecified disorder of muscle ligament and fascia Other malaise and fatigue excluding Chronic Fatigue Syndrome AN SNAP V4 Paediatric Impairment Group 63 CHSD centre for health service development Functional Independence Measure FIM The FIM instrument is a basic indicator of severity of disability It comprises 18 items divided into two major groups Motor items 1 13 and Cognitive items 14 18 Each item is assessed against a seven point ordinal scale where the higher the score for an item the more independently the patient is able to perform the tasks assessed by
86. s single discipline it should be grouped by the Tier 2 classification The AN SNAP V4 grouping methodology will allocate any records that cannot be identified as admitted or multidisciplinary non admitted to an ungroupable class The next split in both the admitted and the non admitted branches is on care type The AN SNAP V4 grouping methodology will designate ungroupable any records that do not have a subacute or non acute care type AN SNAP V4 User Manual 19 CHSD centre for health service development 3 3 2 Paediatric vs adult rehabilitation or palliative care Rehabilitation and palliative care records then split on age If for patients aged between 16 and 19 inclusive Age Type is specified it will override age in the decision of allocating to paediatric or adult classes If neither of these variables is included in the record it will group to the rehabilitation or the palliative care error class This process is the same for the admitted and the non admitted branches 3 3 3 Splits within care type Within each care type the required grouping variables must be available and valid The required total scores will need to be calculated prior to or as part of the grouping process Details of the classes are provided in Sections 4 and 5 Asummary is provided below Admitted adult rehabilitation Same day records are split from the overnight records into a single class All FIM item scores collected on admission must b
87. social needs of the patient and includes negotiated goals within indicative time frames and documented through formal assessment of functional ability Psychogeriatric care is not applicable if the primary focus of care is acute symptom control Ref METeOR ID 491557 Non acute care Non acute care previously referred to as maintenance is care in which the primary clinical purpose or treatment goal is support for a patient with impairment activity limitation or participation restriction due to a health condition Following assessment or treatment the patient does not require further complex assessment or stabilisation Patients with a care type of maintenance care may require care over an indefinite period Ref METeOR ID 491557 Patient Episode Phase definitions Patient A patient client is defined in AN SNAP as a person for whom a health care provider accepts responsibility for assessment and or treatment as evidenced by the existence of a medical record Family carers are included in this definition if interventions relating to them are recorded in the patient client medical record Episode type The episode type variable reflects the setting in which the episode of care is provided There are four options overnight admitted same day admitted non admitted and community The overnight admitted and same day admitted categories are grouped within the admitted branch of AN SNAP V4 while activity provided in a non admitted or
88. t here is to identify the goal that underpinned the period of care preceding the Collection Occasion Because the Focus of Care can change it is necessary to define main when there has been more than one Focus of Care within the period e g flare up of symptoms in a consumer receiving maintenance care such that the focus is now treating the acute symptoms In such circumstances clinicians should choose the main Focus of Care on the basis of the goal that consumed the most treatment effort during the period being rated For example if the Focus of Care was Maintenance for most of the episode and Acute for just a few days the clinician would rate the main Focus of Care as maintenance BThe AMHOCN Focus of Care definition can be found at http amhocn org static files assets e92746f5 Focus of Care pdf AN SNAP V4 User Manual 66 CHSD centre for health service development Health of the Nation Outcome Scale HONOS 65 The HONOS 65 is a 12 item clinician rated measure designed by the Royal College of Psychiatrists specifically for use in the assessment of consumer outcomes in mental health services Ratings are made by clinicians based on their assessment of the consumer In completing their ratings the clinician makes use of a glossary which details the meaning of each point on the scale being rated The most severe problem that occurred over the relevant time period generally the preceding two weeks
89. that item The seven point rating scale designates major graduations in behaviour from total dependence 1 to complete independence 7 The scale provides for the classification of individuals by their ability to carry out an activity independently versus their need for assistance from another person or a device If help is needed the scale assesses the degree of that need The timing of the admission scoring is extremely important because clinically a person s functional capacity changes upon commencement of a program of rehabilitation Admission data should be collected over 24 hours as close to admission to the rehabilitation ward as possible The FIM assessment is undertaken by direct observation and the score should reflect the actual performance observed All clinicians undertaking assessments need to be trained in the use of the FIM instrument and must sit a credentialing exam every two years to ensure consistent and accurate data AROC holds the territory licence for the use of the FIM and WeeFIM instruments in Australia and is the national certification and training centre for these tools Table 17 FIM items 4 Dressing upper body gt 5 Dressing lower body 6 Tolleting gt 8 Bowel management gt 9 Transfer bed chair wheelchair_ 12 METeOR Level of functional independence FIM score web page http meteor aihw gov au content index phtml itemld 449150 AN SNAP V4 User Manual 64 CHSD ce
90. tion Groups Activities of Daily Living Subacute Care Working Group AN SNAP V4 User Manual 5 CHSD centre for health service development 1 Introduction This manual has been designed for users of the Australian National Subacute and Non Acute Patient AN SNAP Version 4 classification The manual has been prepared by the Centre for Health Service Development CHSD University of Wollongong Details of the development of AN SNAP V4 have been reported separately AN SNAP is a casemix classification that includes four subacute care types rehabilitation palliative care geriatric evaluation and management GEM and psychogeriatric care and one non acute care type known previously as maintenance care AN SNAP classifies care across admitted and non admitted settings and is used to classify and fund subacute and non acute services in a number of Australian jurisdictions and internationally 1 1 Context Under the National Health Reform Agreement 2011 the Independent Hospital Pricing Authority IHPA is required to implement a nationally consistent activity based funding ABF system for subacute care services IHPA s determinative function includes developing and specifying the national classifications to be used to classify activity in public hospital services for the purposes of ABF The AN SNAP classification system was selected by IHPA in 2012 as the ABF classification system to be used for subacute and non acute care I
91. to that care type or the patient is admitted to hospital as an overnight patient or the patient is discharged from the service Single day of care without ongoing care plan For the purpose of assignment to the AN SNAP class 4UC1 single day of care without ongoing care plan is defined as occurring when a patient is seen on one day of care and an ongoing care plan is not developed in respect to the care provided Assessment only class For the purpose of assignment to AN SNAP classes 4SY1 and 4VY1 assessment only is defined as occurring when a patient is seen on one occasion only for assessment and or treatment and no further intervention by this service team is planned to occur within the next 90 days If a person is booked seen for subsequent treatment within 90 days they are not assessment only If a person is booked for subsequent assessment but not treatment they are assessment only Treatment For the purpose of assignment to a non admitted AN SNAP psychogeriatric class treatment is defined as any examination consultation or other service provided to a patient that results in an entry into the patient s medical record Phase of palliative care The palliative care phase is the patient s stage of illness within an episode of care in terms of the recognised Palliative Care Phase tool refer Appendix 2 AN SNAP V4 User Manual 48 CHSD centre for health service development Ref METeOR ID 4459
92. tremity Pain 7 4 Pain Syndromes Headache includes migraine 7 5 Pain Syndromes Multi site pain 7 9 Pain Syndromes Other Pain includes abdominal chest wall 8 111 Orthopaedic Fracture Hip unilateral 8 112 Orthopaedic Fracture Hip bilateral AN SNAP V4 User Manual When to use this group and or definitions USE this group for cases in which the major disorder is osteoarthritis arthritis Do NOT use for cases entering rehabilitation immediately after joint replacement even if the procedure was performed secondary to arthritis These should be classified to Post Orthopaedic Surgery 8 211 8 26 USE this group for cases in which the major disorder is arthritis of another aetiology Do NOT use for cases entering rehabilitation immediately after joint replacement even if the procedure was performed secondary to arthritis These should be classified to Post Orthopaedic Surgery 8 211 8 26 USE this group for cases in which the primary purpose for this rehabilitation episode is pain management Do NOT use this group if pain management is only one component of the patient s rehabilitation program These should be classified to the group representing the primary impairment USE this group for cases in which the major disorder is post fracture of bone or post arthroplasty joint replacement USE when joint replacement arthroplasty or hemiarthroplasty is part of the fracture treatment USE t
93. ubacute definitions Australian National Subacute and Non acute Patient Classification AN SNAP AN SNAP is a classification system for classifying subacute and non acute patients into groups which reflect the type and complexity of services provided AN SNAP comprises four subacute care types palliative care rehabilitation psychogeriatric and geriatric evaluation and management and one non acute care type previously referred to as maintenance care Subacute care Subacute care is specialised and multidisciplinary care in which the primary need is optimisation of the patient s functioning and quality of life A person s functioning may relate to their whole body or a body part the whole person or the whole person in a social context and to impairment of a body function or structure activity limitation and or participation restriction Subacute care comprises the defined care types of rehabilitation palliative care geriatric evaluation and management GEM and psychogeriatric care A multidisciplinary management plan comprises a series of documented and agreed initiatives or treatments specifying program goals actions and timeframes which has been established through multidisciplinary consultation and consultation with the patient and or carers Palliative care episodes can include grief and bereavement support for the family and carers of the patient where it is documented in the patient s medical record Ref METeOR ID 548212
94. ured Spontaneous haematoma Spondylosis with myelopathy Spinal infarction Related to congenital heart disease Intervertebral disc disorder with myelopathy Spinal stenosis in cervical region if deficits include weakness Spinal stenosis other than cervical if deficit includes weakness Late effects of spinal cord injury Pathological fracture associated with spinal cord dysfunction An unavoidable recognised surgical complication resulting in spinal cord dysfunction following surgery for the above conditions An unavoidable recognised surgical complication resulting in spinal cord dysfunction following surgery for a Spinal cord injury or disease 55 CHSD centre for health service development AROC Impairment Code 4 211 Traumatic Spinal Cord Dysfunction Paraplegia Incomplete 4 212 Traumatic Spinal Cord Dysfunction Paraplegia Complete 4 2211 Traumatic Spinal Cord Dysfunction Quadriplegia Incomplete C1 4 4 2212 Traumatic Spinal Cord Dysfunction Quadriplegia Incomplete C5 8 4 2221 Traumatic Spinal Cord Dysfunction Quadriplegia Complete C1 4 4 2222 Traumatic Spinal Cord Dysfunction Quadriplegia Complete C5 8 4 23 Traumatic Spinal Cord Dysfunction Other 5 11 Non Traumatic Amputation Of Limb Single Upper Amputation Above the Elbow 5 12 Non Traumatic Amputation Of Limb Single Upper Amputation Below the Elbow 5 13 Non Traumatic Amputation Of Limb Single Lower Amputati
95. ut gt 4CL2 Table 6 Admitted GEM classes AN SNAP V4 User Manual 33 CHSD centre for health service development Figure 7 Admitted psychogeriatric branch Admitted Admitted Psychogeriatric Psychogeriatric Ungroupable ycnog 499D Same Day 4M01 Overactive Behaviour 3 4 Overnight Short Term Care ADS1 HONOS 65 ADL Overactive Behaviour 1 2 gt 4 gt 4DS2 0 3 gt 4DS3 HONOS 65 Total Overactive Behaviour 0 gt 18 48 gt 4DS4 0 17 gt 4DS5 Long Term Care 4DL1 Table 7 Admitted psychogeriatric classes AN SNAP V4 User Manual 34 CHSD centre for health service development Figure 8 Admitted non acute branch Admitted Admitted Non Acute ocne Ungroupable 7 499E RUG ADL Short Term Care 4 11 gt 4ES1 gt p LOS lt 91 age 60 12 15 gt 4ES2 16 18 gt 4ES3 Age 18 59 4ES4 Age lt 17 4ES5 Long Term Care LOS gt 92 4EL1 Table 8 Admitted non acute classes AN SNAP V4 User Manual 35 CHSD centre for health service development 5 The AN SNAP V4 non admitted classes The non admitted branch of AN SNAP V4 comprises 35 classes for adult rehabilitation paediatric rehabilitation adult palliative care paediatric palliative care psychogeriatric care and GEM provided in a non admitted
96. ve Care Problem Severity Score PCPSS is a clinician rated screening tool to assess the overall degree of problems within four key palliative care domains pain other symptoms psychological spiritual and family carer The ratings are 0 absent 1 mild 2 moderate and 3 severe The use of this tool provides an opportunity to assist in the need or urgency of intervention The score triggers a more in depth assessment The four items in this tool are assessed at the beginning of each palliative care phase The total of these scores is used in the non admitted adult palliative care branch of AN SNAP V4 If any of the items is scored 9 not assessed the total cannot be calculated The items are PCPSS at Phase Start Pain PCPSS at Phase Start Other Symptoms PCPSS at Phase Start Psychological Spiritual PCPSS at Phase Start Family Carer For each of the items the scoring options are as follows Table 22 PCPSS scores Score Desitlon o Absent oo 9 Notassessed gt 18 PCOC clinical manual can be found at http ahsri uow edu au content groups public web chsd coc documents doc uow129133 pdf AN SNAP V4 User Manual 70 CHSD centre for health service development Resource Utilisation Group Activities of Daily Living RUG ADL The Resource Utilisation Groups Activities of Daily Living RUG ADL was developed as a tool to measure nursing dependency It describes the level of functional dependence w

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